The correlation between nailfold capillaroscopic findings and adaptive optics imaging of retinal microvasculature in patients with systemic sclerosis

Vascular injury is a central and early feature of systemic sclerosis (SSc) pathogenesis. Although nailfold capillaroscopy (NC) effectively visualizes characteristic peripheral arteriolar and capillary changes, the retinal microcirculation provides a noninvasive, high-resolution view into subtler vascular dysfunction. Consequently, retinal vascular imaging may offer an ideal modality for monitoring microvascular injury and detecting early manifestations of SSc. To compare retinal microvascular parameters between SSc patients and healthy controls using adaptive optics (AO) imaging, and to evaluate the correlation between adaptive optics-derived retinal measurements and NC findings in SSc. The study included 31 patients with SSc and 41 healthy controls. The AO images of the retinal arteries were obtained in both groups and the measurements were compared. Nailfold capillaroscopy was also performed in the SSc cohort, and its findings were directly compared with the AO imaging results. Retinal arterial wall thickness was significantly lower in SSc patients than in healthy controls (p = 0.016), and the wall-to-lumen ratio was similarly reduced in the SSc group (p = 0.048). Within the SSc cohort, hypertensive patients exhibited a significantly greater wall cross-sectional area compared to those without hypertension (p = 0.026). Adaptive optics retinal imaging demonstrated a significant reduction in mean arterial wall thickness in SSc patients compared with healthy controls. However, no correlation was identified between the AO findings and the NC parameters or the disease stage. Our analysis revealed that alterations in retinal vascular parameters were confined to SSc patients with comorbid hypertension or those receiving sildenafil therapy. To fully establish the clinical utility of adaptive optics imaging in SSc, and to elucidate its relationship with NC findings, larger, multicenter studies with more diverse patient cohorts are warranted.