**Background:** Gout is a crystal deposition disease caused by hyperuricemia, leading to monosodium urate crystal accumulation in joints and tissues. Hyperuricemia is associated with cardiovascular disease, but its effects on the retinal microvasculature are not well understood. Optical coherence tomography angiography (OCT-A) is a noninvasive imaging tool that can visualize retinal and choroidal microcirculation. This study aimed to evaluate microangiopathic changes using OCT-A in patients with gout compared to healthy controls.
**Methods:** This cross-sectional study included 30 eyes (right eyes) of 30 patients with gout and 32 eyes (right eyes) of 32 healthy individuals, conducted between January 2021 and May 2022. Exclusion criteria included vascular pathology from systemic diseases other than gout, glaucoma, cataract, retinopathy, keratopathy, congenital ocular anomaly, ocular surgery within 6 months, systemic vascular disease (including diabetes and hypertension), long-term hypertension treatment, pregnancy/lactation, and hypersensitivity to mydriatics. All participants underwent complete ophthalmic examination including slit lamp, best-corrected visual acuity, intraocular pressure (IOP) measurement with Goldman Applanation Tonometry, and fundus examination. OCT-A measurements were obtained after pupil dilation using Optovue AngioVue (RTVue XR Avanti) with a 4.5 × 4.5 mm optic nerve-centered scan. Images were acquired for superficial capillary plexus (SCP), deep capillary plexus (DCP), outer retina (OR), and choriocapillaris (CC). Macular OCT-A images were acquired with AngioPlex (Carl Zeiss Meditec) using a 6 × 6 mm scan model. Statistical analysis used independent sample t-test, Mann-Whitney U test, and Pearson correlation.
**Key Results:** There were no significant differences between groups in age (patient: 58 ± 17 years; control: 57 ± 18 years; p=0.451), BMI (21-25), spherical equivalent (patient: +0.75 ± 1.00; control: +0.50 ± 0.75; p=0.242), axial length (patient: 23.25 ± 1.75 mm; control: 23.50 ± 1.25 mm; p=0.228), or IOP (patient: 12.5 ± 4.8 mmHg; control: 13.1 ± 4.4 mmHg). The superficial foveal and perifoveal vessel densities were significantly lower in the patient group (p=0.014 and p=0.045, respectively), while superficial parafoveal densities were similar (p=0.469 and p=0.284). No significant differences were found in DCP measurements for whole-zone, foveal, parafoveal, or perifoveal vessel densities (p=0.251, p=0.074, p=0.177, and p=0.881, respectively). FAZ, perimeter, and 300-degree peripheral zone measurements were significantly different between groups (p=0.000, p=0.011, and p=0.024, respectively). Choriocapillaris flow zone was significantly lower in the patient group (p=0.008), while OR flow zone showed no difference (p=0.464). RNFL thickness was similar (p=0.693), but C/D ratio was significantly higher in patients (p=0.000). Peripapillary vessel density was significantly decreased in patients (p=0.045). Correlation analysis showed that higher serum uric acid (SUA) levels were independently associated with decreased SCP and increased choriocapillary flow deficit. Women were more sensitive to high SUA levels than men.
**Clinical Implications:** This study demonstrates that gout patients have significant microvascular changes in the retina and choroid, including reduced superficial foveal and perifoveal vessel density, increased choriocapillary flow deficit, and altered FAZ parameters. These changes are associated with higher serum uric acid levels, suggesting that hyperuricemia may contribute to cardiovascular disease through microvascular damage. The findings highlight the potential of OCT-A as a noninvasive tool to detect early microvascular changes in gout patients. The gender difference in sensitivity to SUA levels warrants further investigation. Limitations include single SUA measurement, lack of drug use details, and a Turkish population sample. Further studies are needed to clarify pathophysiology and determine if SUA-targeted treatment improves chorioretinal microcirculation.