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Introduction Systemic sclerosis (SSc) is a debilitating autoimmune disease characterized by a prominent microangiopathy. While well-documented in the skin and nailfold capillaries, the involvement of the retinal microvasculature remains largely uncharacterized. Understanding the prevalence and patterns of these changes is essential for early disease assessment and potentially for guiding management.Material and Methods This cross-sectional study aimed to determine the prevalence and characteristics of retinal involvement in SSc patients and to comparatively assess the diagnostic utility of optical coherence tomography (OCT) against conventional fundus examination.Fifty patients meeting the EULAR/ACR 2013 classification criteria for SSc were enrolled. All participants underwent a comprehensive ophthalmic evaluation, including detailed fundus examination and OCT imaging. The presence and type of retinal abnormalities were systematically recorded and analyzed for both modalities.Results The cohort consisted of 9 men and 41 women (18% and 82%, respectively), with a mean age of 37.2 ± 7.6 years and a mean disease duration of 6.1 ± 2.65 years. Retinal abnormalities were detected in 29 patients (58%), with the most common findings being vascular tortuosity, arteriovenous crossing changes, arterial narrowing, and retinal hemorrhages. Bilateral involvement was observed in 11 patients (37.9% of those with findings). Notably, OCT findings were consistently identical to those from the fundus examination, revealing no additional abnormalities.Conclusions Our findings indicate that retinal involvement is a common manifestation in patients with SSc. However, the study suggests that fundus examination alone is sufficient for detecting these changes. The lack of additional diagnostic yield from OCT suggests that routine OCT screening in asymptomatic SSc patients may be redundant, offering a potential strategy to reduce healthcare costs and minimize unnecessary procedures. Future large-scale studies are warranted to validate these results and to evaluate the prognostic significance of these retinal vascular changes in SSc.