الفهرس 
Introduction
Chapter 1 : Vascular anatomy of the retinaOnly 14 pages are availabe for public view
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Abstract
Systemic sclerosis is a chronic autoimmune inflammatory illness that affects a variety of organs and systems. characterized by vasculopathy and fibrosis of the skin and internal organs. The disease has severe complications like digital ulcers, Raynaud’s phenomenon skin and lung disease, pulmonary arterial hypertension, renal crises, GIT and ocular involvement.
Currently, the most common cause of mortality in those with systemic sclerosis is interstitial lung disease.
Ocular manifestations of systemic sclerosis include dry eye, astigmatism, cataract, glaucoma, eye lid changes, retinal micro vascular abnormalities, diplopia due to ocular myositis, CRAO and CRVO.
The most prevalent ocular symptoms of systemic sclerosis are abnormalities of the skin on the eyelids and abnormalities of the retina.
Although the pathophysiology of the ocular disease is not yet identified, immune complex vasculopathy and inflammatory mediators may be involved.
Retinal damage can range from minor vascular alterations to vision-threatening vaso-occlusive retinopathy.
Through the use of motion contrast imaging, OCTA enables noninvasive observation of the retinal and choroidal vasculature.
So, the objective of this study was to evaluate the OCTA results in systemic sclerosis patients and compare them to age-matched healthy controls to detect any sub clinical structural or micro vascular changes on the retina.
This was a prospective observational case-control study, which included a total of 80 eyes of 40 participants (40 eyes of 20 normal control, 40 eyes of 20 patients with systemic sclerosis).
At Minia University Hospital, the study was carried out. The patients were recruited from the rheumatology department and the healthy controls were recruited from ophthalmology out-patient clinic. All patients subjected to history taking and full ophthalmological examination before performing OCTA. OCTA parameters included VD at SCP, DCP and Choriocapillaris in the fovea, Parafovea, inferior, superior, nasal and temporal regions of the retina and OCTA thickness at the fovea, Parafovea, superior, inferior, nasal and temporal regions of the retina.
In group I (systemic sclerosis patients), the mean age was 41.1 years (ranged from 30 to 60 years).The mean vessel density at SCP was (30.1 at the fovea,49.1 at Parafovea,49.1 at the temporal region,49.5 at the superior region,48.5 at the nasal region,49.2 at the inferior region) .The mean vessel density at DCP was (31.1 at the fovea55.4 at Parafovea, 54.9 at the temporal region, 55.6 at the superior region, 54.9 at the nasal region, and 54.6 at the inferior region).The mean vessel density at CC was (64.9 at the fovea, 65.8 at Parafovea, 66.3 at the temporal region, 65.7 at the superior region, 65.5 at the nasal region, and 65.4 at the inferior region). The OCTA thickness at SCP was (235 at the fovea, 296 at Parafovea, 281 at the temporal region, 302 at the superior region, 296 at the nasal region, and 299 at the inferior region).
In group II (control group), the mean age was 38.3 years (ranged from 30 to 55 years).The mean vessel density at SCP was (28.7 at the fovea, 52.0 at Parafovea, 52.3 at the temporal region, 52.1 at the superior region, 52.1 at the nasal region, 51.4 at the inferior region) The mean vessel density at DCP was (28.1 at the fovea, 62.3 at Parafovea, 61.8 at the temporal region,63.5 at the superior region,61.9 at the nasal region,62.2 at the inferior region) The mean vessel density at CC was (63.9 at the fovea,65.7 at Parafovea,64.4 at the temporal region,65.5 at the superior region,65.5 at the nasal region,65.6 at the inferior region).. The OCTA thickness at SCP was (233 at the fovea, 308 at Parafovea, 299 at the temporal region, 315 at the superior region, 312 at the nasal region, and 314 at the inferior region).
In group I (systemic sclerosis group), the mean BCVA 0.495±0.126 (ranged from 0.200 to 0.700).In group II (control group), the mean BCVA 0.843±0.101 (ranged from 0.700 to 1.00).
Conclusion
In SSc patients, OCTA study demonstrated impairment of retinal microperfusion, confirming the presence of vascular damage. As soon as SSc is diagnosed, retinal and choroidal evaluations should be taken into consideration in order to spot any early abnormalities.
In comparison to the control group, our study’s findings showed a significantly lower BCVA and lower vessel density at the SCP and DCP. Also the thickness in the Parafoveal scan, temporal, superior, and nasal regions show a significant reduction in the systemic sclerosis groups.
So, In order to identify any sub-clinical alterations in patients with systemic sclerosis, we recommended using OCTA, despite no ocular manifestation.