Objective: Systemic sclerosis (SSc) is characterized by a diffuse microvascular disease that contributes to organ damage and increased cardiovascular risk. The retinal microcirculation provides a non-invasive window to assess vascular structure and function, while the renal resistive index (RRI) reflects renal and systemic vascular damage. The relationship between retinal microcirculation, blood pressure and cumulative disease damage in SSc remains unclear. Design and method: Consecutive patients with SSc underwent retinal microvascular assessment before and during intravenous prostaglandin infusion. Retinal structural parameters (wall-to-lumen ratio WLR, wall cross-sectional area, wall thickness) and functional parameters (baseline and post-flicker light induced dilation diameters, delta and percentage change) were measured by Adaptive Optics. Blood pressure was recorded in both conditions. Renal involvement was assessed using mean renal resistive index (RRI) only before intravenous prostaglandin infusion. Disease duration and Charlson Comorbidity Index (CCI) were collected. Paired comparisons and correlation analyses (Pearson) were performed. Results: Diastolic blood pressure significantly decreased during prostaglandin infusion (p=0.017), while systolic blood pressure showed a non-significant reduction. Retinal structural parameters did not change acutely during infusion. Retinal WLR correlated with systolic blood pressure both before (r=0.45, p=0.002) and during infusion (r=0.40, p=0.005), and with age (r=0.51, p<0.001). During infusion, retinal functional parameters were inversely associated with systolic blood pressure (p<0.01). Higher comorbidity burden, assessed by CCI, was associated with greater retinal microvascular remodeling (WLR and wall thickness, p<0.05) and with reduced retinal functional response under vasoactive stimulation (p<0.05). Mean RRI correlated with disease duration (r=0.29, p=0.047), but not with retinal structural parameters. Conclusions: In systemic sclerosis, retinal microvascular structure reflects blood pressure and comorbidity load, while impaired retinal functional reserve under vasoactive stimulation is associated with higher comorbidity burden. Renal microcirculation shows a progressive relationship with disease duration, supporting a complementary role of retinal and renal vascular assessment in hypertensive SSc patients.
Bevacqua et al. (Fri,) studied this question.