Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 3;15(13):1701.
doi: 10.3390/diagnostics15131701.

Macular Microvasculature Is Different in Patients with Primary Sjögren's Disease Compared to Healthy Controls

Gyde Tadsen  1   2 , Nadine Zehrfeld  1 , Laura Hoffmann  2 , Marten Gehlhaar  2 , Bettina Hohberger  3 , Christian Mardin  3 , Torsten Witte  1 , Carsten Framme  2 , Diana Ernst  1 , Katerina Hufendiek  2
Affiliations

Macular Microvasculature Is Different in Patients with Primary Sjögren's Disease Compared to Healthy Controls

Gyde Tadsen et al. Diagnostics (Basel). .

Abstract

Background/Objectives: This study investigates the macular microvasculature in a large cohort of primary Sjögren's disease (SjD) patients using optical coherence tomography angiography (OCTA), focusing on how disease duration, activity, and hydroxychloroquine (HCQ) treatment influence retinal microcirculation. Methods: A total of 106 eyes (53 SjD patients) and 70 eyes (35 age- and gender-matched healthy controls (HCs)) were examined. The vessel area density (VAD, %) and foveal avascular zone (FAZ, mm2) were measured in three retinal layers: Superficial Vascular Plexus (SVP), Intermediate Capillary Plexus (ICP), and Deep Capillary Plexus (DCP), respectively, in three peri-macular circular sectors (c1, c2, c3) each. Results: The VAD was significantly lower in c1 of the DCP in SjD compared to HCs (29.14 ± 7.07 vs. 31.78 ± 9.55, p = 0.038). The FAZ was significantly larger in SjD in both SVP (0.41 ± 0.13 vs. 0.34, 0.11, p < 0.001; Cohen's |d| = 0.55) and DCP (0.45 ± 0.15 vs. 0.4 ± 0.14, p = 0.014; Cohen's |d| ± 0.38). Significant correlations were observed between the FAZ size and reductions in the VAD in the SVP and DCP (p = 0.010, Cohen's |d| = 0.2; p < 0.001, Cohen's |d| ± 0.26) and across all layers combined (p = 0.019, Cohen's |d| = -0.18). Conclusions: There was a negative correlation between the VAD in the DCP and disease duration (ρ = -0.28, p = 0.040). No significant correlation was identified between the duration of HCQ intake and the VAD or FAZ. Our findings indicate microvascular alterations in the DCP of SjD, characterized by a reduced VAD and an enlarged FAZ, which may be attributable to inflammatory or arteriosclerotic factors. OCTA may prove to be a valuable tool for the stratification of vascular risk in SjD.

Keywords: OCTA imaging; Sjögren’s disease; macular microvasculature; retinal biomarker.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest: The authors declare no relevant conflicts of interest to disclose. Outside the submitted work, the authors received honoraria for lectures, travel grants, or research grants. G.T.: no conflicts of interest. L.H.: nothing to declare. M.G.: nothing to declare. N.Z.: received a scholarship by Else Kröner Fresenius Foundation, research grants by Novartis, and financial support for conference attendance by Abbvie. B.H.: received honoraria from Abbvie; B.H. received funding from the DFG, BMBF, BMG, StMWK, LGL, and Gliead. C.M.: nothing to declare. T.W.: received honoraria for lectures by Abbvie, BMS, Chugai, Galapagos, Janssen, Lilly, Pfizer, UCB, and Roche. T.W. received funding from the DFG (German Research Foundation) under Germany’s Excellence Strategy—EXC 2155—project number 390874280. C.F.: nothing to declare. D.E.: received presentation honoraria from Abbvie, Amgen, BMS, Chugai, Cilag-Janssen, Galapagos, GSK, Medac, Lilly, Pfizer, Novartis, and Roche; participated in advisory boards for Abbvie, Galapagos, Amgen, and Novartis; and received research grants from Novartis and Abbvie. K.H.: no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of patient recruitment with exclusion criteria consideration.
Figure 2
Figure 2
OCTA images of (a) Superficial Vascular Plexus (SVP), (b) intermediate capillary plexus (ICP), and (c) Deep Capillary Plexus (DCP) surrounding the macula. In the middle of the picture is the foveal avascular zone. Illustrations were created with the Heidelberg Eye Explorer.
Figure 3
Figure 3
(a–c): (a) Superficial Vascular Plexus (SVP), (b) intermediate capillary plexus (ICP), and (c) Deep Capillary Plexus (DCP). Region of interest: Macula with circular segmentation of the three peri-macular sectors, c1, c2, c3. The first circle has a radius of 0.40 mm. The radius increment of each circular sector is 0.35. (d–f): Binarized images analyzed with the Erlangen Angio Tool with circular segmentation and analysis in 12 sectors of (d) Superficial Vascular Plexus (SVP), (e) intermediate capillary plexus (ICP), and (f) Deep Capillary Plexus (DCP) surrounding the macula. In the middle of the picture is the foveal avascular zone.
Figure 4
Figure 4
Measurement of the foveal avascular zone (FAZ) in (a) Superficial Vascular Plexus (SVP), (b) intermediate capillary plexus (ICP), and (c) Deep Capillary Plexus (DCP).
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Westhoff G., Zink A. Epidemiology of Primary Sjörgren’s Syndrome. Z. Rheumatol. 2010;69:41–49. doi: 10.1007/s00393-009-0518-3. - DOI - PubMed
    1. Bowman S.J., Ibrahim G.H., Holmes G., Hamburger J., Ainsworth J.R. Estimating the Prevalence among Caucasian Women of Primary Sjögren’s Syndrome in Two General Practices in Birmingham, UK. Scand. J. Rheumatol. 2004;33:39–43. doi: 10.1080/03009740310004676. - DOI - PubMed
    1. Birlik M., Akar S., Gurler O., Sari I., Birlik B., Sarioglu S., Oktem M.A., Saglam F., Can G., Kayahan H., et al. Prevalence of Primary Sjogren’s Syndrome in Turkey: A Population-Based Epidemiological Study. Int. J. Clin. Pract. 2009;63:954–961. doi: 10.1111/j.1742-1241.2008.01749.x. - DOI - PubMed
    1. Zippel C.L., Beider S., Kramer E., Konen F.F., Seeliger T., Skripuletz T., Hirsch S., Jablonka A., Witte T., Sonnenschein K., et al. Premature Stroke and Cardiovascular Risk in Primary Sjögren’s Syndrome. Front. Cardiovasc. Med. 2022;9:1048684. doi: 10.3389/fcvm.2022.1048684. - DOI - PMC - PubMed
    1. Zehrfeld N., Abelmann M., Benz S., Zippel C.L., Beider S., Kramer E., Seeliger T., Sogkas G., Gödecke V., Ahrenstorf G., et al. Primary Sjögren’s Syndrome Independently Promotes Premature Subclinical Atherosclerosis. RMD Open. 2024;10:e003559. doi: 10.1136/rmdopen-2023-003559. - DOI - PMC - PubMed

LinkOut - more resources