Abstract
Purpose :
Psoriasis is a chronic inflammatory disorder that has been associated with systemic comorbidities, including arthritis, cardiovascular disease, and diabetes. Recently, psoriatic inflammation has been identified as an independent risk factor for MI, stroke, and death. It is critical for us to determine earlier correlates for inflammation from psoriasis. It is known that ultrawidefield angiography can often detect peripheral vascular leakage (PVL) as a very early marker of inflammation in other conditions with an autoimmune basis. The purpose of this study was to determine if peripheral vascular leakage on ultrawidefield angiography was evident in patients with psoriasis and if this correlated to their clinical disease severity.
Methods :
This was a cross sectional, IRB-approved, prospective study comparing ultrawidefield angiography in patients with psoriasis to healthy age-matched controls. Subjects with severe psoriasis based on body surface area (BSA), psoriasis area severity index (PASI), and physician global assessment (PAGA) were recruited from the EVMS dermatology clinic. They then had a complete ophthalmologic exam along with OCT and ultrawidefield angiography. Each diagnostic image was reviewed by two retinal physicians for concordance.
Results :
28 patients were enrolled in the study (mean age = 49.75 years) including 19 females and 9 males. Average duration of psoriasis was 9.97 years, with average BSA of 4.96, average PASI of 4.58, and average PAG of 1.93. PVL was detected in 6 psoriasis patients (21.4%) compared to 1 (3.6%) in healthy age-matched controls (p<0.05). No patients in the psoriasis subgroup had clinically evident uveitis on exam, suggesting PVL was an early marker of ocular inflammation in all 6 patients. The subset of patients with PVL had greater duration of psoriasis disease burden (14.5 vs. 8.74 years, p<0.05), greater PASI (5.35 vs. 4.37), and greater PGA (2.17 vs. 1.86).
Conclusions :
Peripheral retinal vascular leakage on ultrawidefield angiography is an early marker of ocular inflammation in patients with psoriasis. PVL also correlated favorably as a marker for overall psoriasis severity, with positive associations with disease duration, PASI, and PGA. Further studies are needed to correlate PVL to other aspects of psoriasis disease burden.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.