# Utilizing Shear Wave Elastography for the Evaluation of Ocular Involvement in Systemic Sclerosis

## TL;DR

This study uses a new imaging technique to find that systemic sclerosis affects eye tissues, showing increased stiffness in fat behind the eye.

## Contribution

First use of shear wave elastography to detect ocular involvement in systemic sclerosis, revealing increased retrobulbar adipose tissue stiffness.

## Key findings

- Retrobulbar adipose tissue in SSc patients showed significantly higher elasticity and velocity values compared to controls.
- Digital ulcers in SSc patients were strongly associated with increased stiffness in the retina–choroid–sclera complex.
- No significant differences were observed in the optic disc or optic nerve tissues between SSc patients and controls.

## Abstract

Background: Several imaging studies have confirmed ocular involvement in systemic sclerosis (SSc). However, elastography has not yet been used for this purpose in the literature. Thus, this study aimed to evaluate ocular involvement in SSc using shear wave elastography (SWE). Methods: This study included 29 SSc patients and 30 age- and sex-matched healthy controls. All participants underwent independent ophthalmological evaluations by two ophthalmologists. Subsequently, SWE was used to evaluate the retina–choroid–sclera (RCS), optic disc (OD), optic nerve (ON), and retrobulbar adipose tissue (RBFT) of the right eye. The median shear wave elasticity (kPa) and velocity (m/s) values were automatically calculated using the ultrasound device’s integrated software. Results: The elasticity and velocity values of RBFT in SSc patients were significantly higher than those in the control group. However, no notable differences were observed in other analyzed areas. A strong association was found between digital ulcers and velocity values of the RCS, while no significant differences were noted for other parameters. Conclusions: This study revealed increased stiffness in the RBFT of SSc patients. To our knowledge, this is the first evidence suggesting that SSc can affect RBFT. Further studies are required to confirm this finding and investigate its link to the disease. Additionally, we found a strong association between digital ulcers and increased RCS stiffness. Using SWE for the first time, we have demonstrated that microcirculatory disruption in SSc extends beyond the skin and can affect multiple tissues simultaneously.