Pos1254 Investigation of Macular Microvasculature Alterations in a Large Cohort of Primary Sjögren Syndrome Patients in Comparison to Healthy Controlls

Background: Primary Sjögrens syndrome (pSS) is a chronic, progressive, inflammatory, autoimmune disease, characterized by mononuclear cell infiltration of exocrine glands, notably the lacrimal gland. These lymphoid infiltrations lead to dryness of the eyes, also known as keratoconjunctivitis sicca. However, it is uncertain whether ocular microvascular alterations are associated with this disease. Objectives: This study aims to investigate the macular microvasculature and explore the OCTA (OCT Angiography) metrics as potential retinal biomarkers in a large cohort of patients with primary Sjögrens syndrome. Methods: From September 2022 to July 2023, pSS patients from the outpatient clinic of our hospital were consecutively included after informed consent. In addition, age- and sex-matched control subjects were recruited. All pSS patients fulfilled current EULAR classification criteria for pSS and had a disease duration of at least 5 years. Participants with additional diabetes mellitus, tumor diseases in the last five years (with chemotherapeutic treatment), glaucoma or increased intraocular pressure or known eye diseases (not pSS related) were excluded from this study. Data collection was performed by a standardized questionnaire, slit lamp, Schirmer I and II test, tensio, vision test, OCT and OCTA. A prospective study of 100 eyes of 50 pSS patients compared to 80 eyes of 40 healthy, age-matched controls. All participants underwent 2.9 mm × 2.9 mm imaging of the macula using the OCTA (Heidelberg Spectralis II, Heidelberg, Germany). The outcome variables were vessel Area Density (VAD) in circular sectors (c1, c2, and c3) and foveal avascular zone (FAZ). Both variables were measured in three layers: superficial (SVP), intermediate (ICP) and deep capillary Plexus (DCP). All scans were analyzed with the EA-Tool (coded in MATLAB, The MathWorks Inc, and R2017b). Results: VAD was significantly lower in the innermost circle of DCP c1 in the pSS group compared to healthy controls (29.14± 7.07 vs. 31.78± 9.55, p=0.03). FAZ was larger in both SVP (0.41± 0.13 vs.0.34± 0.11, p< 0.001; Cohens |d| = 0.55) and DCP (0.45± 0.15 vs. 0.4± 0.14, p=0.01; Cohens |d| = 0.38) in pSS group compared to healthy controls. Conclusion: Our findings indicate microvascular changes in the deep capillary layers of pSS patients, showing reduced vessel area density and enlarged FAZ. This could be due to inflammatory or arteriosclerotic etiology. OCTA could be beneficial as retinal biomarker for vascular risk stratification in pSS. Further longitudinal studies need to be considered in future studies for validation and implementation of the OCTA in the course of pSS. REFERENCES: [1] Yang QC, Yao F, Li QY, Chen MJ, Zhang LJ, Shu HY, Liang RB, Pan YC, Ge QM, Shao Y. Ocular microvascular alteration in Sjögren syndrome. Quant Imaging Med Surg. 2022 Feb;12(2):1324-1335. doi: 10.21037/qims-21-234. PMID: 35111627; PMCID: PMC8739119. [2] Yu C, Zou J, Ge QM, Liao XL, Pan YC, Wu JL, Su T, Zhang LJ, Liang RB, Shao Y. Ocular microvascular alteration in Sjögren's syndrome treated with hydroxychloroquine: an OCTA clinical study. Ther Adv Chronic Dis. 2023 Apr 17;14:20406223231164498. doi: 10.1177/20406223231164498. PMID: 37114215; PMCID: PMC10126603. [3] Lee OL, Tepelus TC, Huang J, Irvine AG, Irvine C, Chiu GB, Sadda SR. Evaluation of the corneal epithelium in non-Sjögren's and Sjögren's dry eyes: an in vivo confocal microscopy study using HRT III RCM. BMC Ophthalmol. 2018 Dec 4;18(1):309. doi: 10.1186/s12886-018-0971-3. PMID: 30514255; PMCID: PMC6278105. [4] Roszkowska AM, Oliverio GW, Aragona E, Inferrera L, Severo AA, Alessandrello F, Spinella R, Postorino EI, Aragona P. Ophthalmologic Manifestations of Primary Sjögren's Syndrome. Genes (Basel). 2021 Mar 4;12(3):365. doi: 10.3390/genes12030365. PMID: 33806489; PMCID: PMC7998625. [5] Hosari S, Hohberger B, Theelke L, Sari H, Lucio M, Mardin CY. OCT angiography: measurement of retinal macular microvasculature with spectralis II OCT angiography: reliability and reproducibility. Ophthalmologica. 2020;243(1):75–84 Acknowledgements: NIL. Disclosure of Interests: None declared.