Changes of the retinal and choroidal vasculature in cerebral small vessel disease

Clara F Geerling,Christopher A Turski,S Magdalena Langner,Maximillian W M Wintergerst,Robert P Finger,Gabor C Petzold,Gabrielle N Turski,Jan H Terheyden,Vera C Keil,Christine Kindler

doi:10.1038/s41598-022-07638-x

Abstract

Cerebral small vessel disease (CSVD) is associated with changes in the retinal vasculature which can be assessed non-invasively with much higher resolution than the cerebral vasculature. To detect changes at a microvascular level, we used optical coherence tomography angiography which resolves retinal and choroidal vasculature. Participants with CSVD and controls were included. White matter lesions were determined on magnetic resonance imaging (MRI). The retinal and choroidal vasculature were quantified using swept-source optical coherence tomography angiography. Data were analysed using linear regression. We included 30 participants (18 females; patients, n = 20; controls, n = 10) with a mean age of 61 ± 10 years. Patients had a higher mean white matter lesion index and number of lesions than controls (p ≤ 0.002). The intraindividual deviation of choriocapillaris reflectivity differed significantly between age-matched patients (0.234 ± 0.012) and controls (0.247 ± 0.011; p = 0.029). Skeleton density of the deep retinal capillaries was significantly associated with the number of lesions on MRI (β = − 5.3 × 108, 95%-confidence interval [− 10.3 × 108; − 0.2 × 108]) when controlling for age. The choroidal microvasculature and the deep retinal vascular plexus, as quantified by optical coherence tomography angiography, are significantly altered in CSVD. The value of these findings in diagnosing or monitoring CSVD need to be assessed in future studies.

Highlights

In this study we found choroidal perfusion altered in Cerebral small vessel disease (CSVD) compared to healthy controls which has not been described in CSVD previously
The extent of CSVD on magnetic resonance imaging (MRI) was associated with a reduced blood flow in the capillaries of the deep retinal plexus independent of age-related changes
Our results indicate that the high-resolution assessment of the choroidal and retinal microvasculature using OCT-A might aid in detecting and monitoring CSVD but additional studies are needed to better characterize these associations

Summary

Introduction

The unadjusted area under the ROC curve to detect participants with CSVD was significant for the choriocapillaris reflectivity standard deviation on OCT-A (0.735, 95%-confidence interval [0.544; 0.926], p = 0.039) (Supplementary Table 2 Supplementary Fig. 1). The logarithmically transformed WMI values as well as number of lesions were significantly associated with vessel density, vessel diameter index in both superficial and deep plexus as well as choriocapillaris parameters in unadjusted analyses (Supplementary Fig. 2). In an age-matched analysis of 10 cases and 10 controls, choriocapillaris reflectivity standard deviation differed significantly between the groups (Table 1).

Results

Conclusion