Structural Features of Patients with Drusen-like Deposits and Systemic Lupus Erythematosus

Ocular fundus changes and association with systemic conditions in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple organs and systems. Ocular involvement is estimated to manifest in one-third of individuals with SLE, of which lupus retinopathy and choroidopathy represent the severe subtype accompanied by vision impairment. Advancements in multimodal ophthalmic imaging have allowed ophthalmologists to reveal subclinical microvascular and structural changes in fundus of patients with SLE without ocular manifestations. Both ocular manifestations and subclinical fundus damage have been shown to correlate with SLE disease activity and, in some patients, even precede other systemic injuries as the first presentation of SLE. Moreover, ocular fundus might serve as a window into the state of systemic vasculitis in patients with SLE. Given the similarities of the anatomy, physiological and pathological processes shared among ocular fundus, and other vital organ damage in SLE, such as kidney and brain, it is assumed that ocular fundus involvement has implications in the diagnosis and evaluation of other systemic impairments. Therefore, evaluating the fundus characteristics of patients with SLE not only contributes to the early diagnosis and intervention of potential vision damage, but also holds considerate significance for the evaluation of SLE vasculitis state and prediction of other systemic injuries.

Unveiling Ocular Manifestations in Systemic Lupus Erythematosus

Systemic Lupus Erythematosus (SLE) is a complex autoimmune disorder characterized by immune dysregulation and multi-organ involvement. In this concise brief review, we highlight key insights into Ocular Systemic Lupus Erythematosus (SLE), an intricate autoimmune disorder with diverse organ involvement. Emphasizing the formation of autoantibodies and immune complex deposition, we delve into the inflammation and damage affecting ocular structures. Clinical presentations, ranging from mild dry eye syndrome to severe conditions like retinal vasculitis, necessitate a comprehensive diagnostic approach, including clinical exams, serological testing, and imaging studies. Differential diagnosis involves distinguishing SLE-related ocular manifestations from other autoimmune and non-inflammatory ocular conditions. The multidisciplinary management approach, involving rheumatologists, ophthalmologists, and immunologists, tailors treatment based on ocular involvement severity, encompassing corticosteroids, immunosuppressive agents, and biologics. Follow-up is crucial for monitoring disease progression and treatment response. Future perspectives revolve around advancing molecular understanding, refining diagnostic tools, and exploring targeted therapies. Novel research areas include genetic factors, microbiome composition, and biotechnology for tailored and effective SLE ocular treatments.

Multiple Bilateral Retinal Pigment Epithelial Detachments in a Patient with Systemic Lupus Erythematosus: A Case Report

Purpose

To report a case of multiple bilateral retinal pigment epithelial detachments (PEDs) in a woman with systemic lupus erythematosus (SLE).

Methods

Case Report.

Results

A 28-year-old female with mild blurred bilateral vision in both eyes (OU) without pain or any other symptom was admitted to the hospital due to worsening renal function and uncontrolled high blood pressure (HBP). Best-corrected visual acuity (BCVA) was 20/30 and 20/40, right and left eyes, respectively. She had SLE, glucose-6-phosphate dehydrogenase deficiency, and immune thrombocytopenic purpura. BP was over 150/90 mmHg for more than 1.5 years, and she used corticosteroids at varying doses for more than 4 years. During hospitalization, she was taking prednisone 60 mg daily as Class IV lupus nephritis was diagnosed. On fundoscopy, she had a lacy retinal pattern, remarkably on the macula in OU. Spectral-domain optical coherence tomography revealed multiple bilateral serous PEDs and pachychoroid. Angiofluoresceinography displayed multiple pooling hyperfluorescence areas. Six months afterward, while she was on prednisolone 10 mg daily, and antihypertensive medications, BCVA was improved to 20/25 OU. Nevertheless, she had no retinal or choroidal changes. Her findings could be related to SLE choroidopathy, central serous chorioretinopathy-like disease, and/or hypertensive choroidopathy.

Conclusions

Ocular involvement affects nearly one-third of SLE patients. The findings are variable and can include nearly any part of the eyeball. Multiple bilateral PEDs have been described in the literature; however, in this case, it is probably multifactorial and not only related to SLE.

Functional and Morphological Characteristics of the Retina of Patients with Drusen-like Deposits and Systemic Lupus Erythematosus Treated with Hydroxychloroquine: A Retrospective Study

PURPOSE

To evaluate the impact of drusen-like deposits (DLD) on retinal layer integrity and retinal function by optical coherence tomography (OCT) and multifocal electroretinography (mfERG) in patients with systemic lupus erythematosus (SLE).

METHODS

We identified 66 eyes of 33 SLE patients treated with hydroxychloroquine (HCQ) that were categorized into two groups according to whether DLDs were present (34 eyes, Group One) or absent (32 eyes, Group Two). The groups were matched for age, sex, HCQ treatment duration, daily, and cumulative dosage. OCT (retinal layer thicknesses, central retinal thickness, CRT) and mfERG concentric ring analysis were analyzed and compared.

RESULTS

CRT was significantly thicker in Group One compared to Group Two (273.21 ± 3.96 vs. 254.5 ± 7.62) (p = 0.023). Group One also demonstrated an overall thicker retinal pigment epithelium compared to Group Two; however, the other outer retinal layers, outer nuclear layer, and photoreceptor layer were found to be significantly thinner in Group One compared to Group Two. We found no differences in mfERG parameters between the two groups.

CONCLUSIONS

DLDs in SLE patients lead to abnormal central retinal layer thickness, which has no measurable impact on cone-mediated retinal function assessed by mfERG.