Want to know about retinal and choroidal vascular parameters in patients with CSC? Look to their nails

An experienced dermatologist blinded to clinical data performed the NVC using a videocapillaroscope VideoCap 3.0 (DSMedica) at 200× magnification in the study. (Image Credit: ©Stepan Popov - Adobe.Stock.com)

Polish investigators, led by Malgorzata Latalska, MD, reported that nailfold videocapillaroscopy (NVC) is a potential tool to assess the central serous chorioretinopathy (CSC) prognosis in affected patients, based on the observed digital microcirculation abnormalities.¹ She is from the Department of General and Pediatric Ophthalmology, Medical University of Lublin, Lublin, Poland.

NVC, according to the authors, “is one of the best diagnostic imaging techniques for studying microcirculation in vivo. It is a non-invasive, repeatable, simple and inexpensive method that directly permits microcirculation assessment.² It is widely used in diagnosing microvascular pathologies in dermatologic and rheumatologic conditions, as well as in diabetes mellitus and arterial hypertension,” among others.

NVC study

A total of 152 patients with acute, recurrent, chronic, and neovascular CSC were included (118 men; mean patient age, 45.9 years) and 41 healthy controls (29 men; mean patient age, 47 years). All participants underwent an NVC examination, ophthalmoscopy, optical coherence tomography (OCT) and OCT angiography. The medical history regarding chronic general disorders and known risk factors was recorded.

The investigators explained the NVC procedure. An experienced dermatologist blinded to clinical data performed the NVC using a videocapillaroscope VideoCap 3.0 (DSMedica) at 200× magnification. The nailfold capillaries of the second to fifth fingers on both hands were examined. During the NVC, the capillary distribution (i.e., capillary architecture), capillary length, capillary morphology (i.e., meandering capillaries, coiled capillaries, tortuous capillaries, bushy-ramified capillaries, and angiogenesis), capillary diameter (i.e., dilated capillaries (>20 µm), dilated apical part of capillaries, capillary enlargement (30–50 µm), megacapillaries (>50 µm), capillary density (normal 9–14 capillaries/mm), the presence of microhemorrhages and microaneurysms, and the visibility of subpapillary venular plexus were evaluated.

The researchers reported that only the patients with CSC had abnormal NVC patterns and an abnormal dilated apical part of the capillaries (p = 0.000). Neoangiogenesis was observed in 25 (58.14%) patients with acute CSC, 22 (42.31%) with recurrent CSC, 16 (36.36%) with chronic CSC, 5 (45.45%) with neovascular CSC, and 2 (4.88%) controls (p = 0.000). Glomerular capillaries were found in 8 (18.6%), 17 (31.48%), 25 (56.82%) and 8 (72.73%) patients with acute, recurrent, chronic, and neovascular CSC, respectively (p = 0.000). Meandering capillaries were seen more often in patients with acute and recurrent CSC and glomerular capillaries in chronic and aneurysmal dilations in neovascular CSC.

The authors concluded that the “observed digital microcirculation abnormalities in patients with CSC, such as dilation, meandering, tortuosity and glomerular, may confirm systemic microvasculopathy. The potential role of the NVC examination in assessing the CSC prognosis requires further evaluation.”

References:

1. Latalska M, Bartosińska J, Dresler S, et al. Comparison of nailfold videocapillaroscopy with retinal and choroidal vascular parameters in patients with central serous chorioretinopathy. J Clin Med.2023;12:4817. https://doi.org/10.3390/jcm12144817

2. Cutolo M, Pizzorni C, Secchi ME, Sulli A. Capillaroscopy. Best Pract Res Clin Rheumatol. 2008;22:1093–1108.

3. Kosior-Jarecka E, Bartosińska J, Łukasik U, et al. Results of nailfold capillaroscopy in patients with normal-tension glaucoma. Curr Eye Res. 2018;43:747–753.