Inaugural severe vaso-occlusive retinopathy in systemic lupus erythematosus

Optical coherence tomography angiography findings in systemic lupus erythematosus patients with no ocular disease

PURPOSE

Retinal manifestations are present in 10% of patients with systemic lupus erythematosus (SLE) and consist of vascular changes that can be sight-threatening. Optical coherence tomography angiography (OCTA) is a novel imaging modality that detects movement inside the blood vessels without dye injection and transforms this movement into an angiographic map. The aim of this study is to describe subclinical vessels changes in the eyes of patients with SLE but no retinal manifestations.

METHODS

In this cross-sectional study, 15 patients with SLE but no clinical ophthalmic manifestations were scanned through OCTA of the iris and at the level of the macula. Qualitative aspects of the iris vessels, and measure of the foveal avascular zone (FAZ) and vessel density were compared to a cohort of 15 normal controls.

RESULTS

Patients with SLE, even in the absence of ophthalmic manifestations, present a qualitative increase in the iris vessels flow, and enlargement of the FAZ (0.22 ± 0.12 mm²) and a decrease in the vascular density (11.221 ± 1.933 mm^-1) of the superficial capillary plexus on OCTA that cannot be highlighted clinically.

DISCUSSION

OCTA can be used in a noninvasive way to detect subclinical vascular changes in patients with SLE. How this information will influence the follow-up and management of these cases will require further prospective studies with a collaborative effort between ophthalmologists and rheumatologists.

Ocular manifestations in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) can involve many parts of the eye, including the eyelid, ocular adnexa, sclera, cornea, uvea, retina and optic nerve. Ocular manifestations of SLE are common and may lead to permanent blindness from the underlying disease or therapeutic side effects. Keratoconjunctivitis sicca is the most common manifestation. However, vision loss may result from involvement of the retina, choroid and optic nerve. Ocular symptoms are correlated to systemic disease activity and can present as an initial manifestation of SLE. The established treatment includes prompt systemic corticosteroids, steroid-sparing immunosuppressive drugs and biological agents. Local ocular therapies are options with promising efficacy. The early recognition of disease and treatment provides reduction of visual morbidity and mortality.