Analysis of Clinical Factors Associated with Retinal Morphological Changes in Patients with Primary Sjögren's Syndrome

Abstract

PurposeTo investigate clinical factors associated with abnormal retinal morphologies in patients with primary Sjögren's syndrome (pSS).MethodsOne-hundred-thirty patients with pSS who underwent immunoserological tests, minor salivary gland biopsies, and optical coherence tomography examinations were retrospectively analyzed. Risk factors for abnormally reduced peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell–inner plexiform layer (mGCIPL) thicknesses were evaluated, as well as the correlation between clinical factors and pRNFL and mGCIPL thicknesses.ResultsAnti-Sjögren's syndrome type B (SSB) antibody positivity (P = 0.048) was identified as a risk factor associated with abnormally reduced pRNFL thickness, and anti-SSB positivity (P = 0.005) and erythrocyte sedimentation rate (ESR) level (P = 0.031) were identified as risk factors associated with an abnormally reduced mGCIPL thickness as revealed by multivariate logistic regression analysis. There was a significant negative correlation between anti-SSB antibody levels and the thickness of pRNFL and mGCIPL. The thicknesses of pRNFL and mGCIPL were significantly reduced in anti-SSB–positive eyes when compared to anti-SSB–negative eyes (P < 0.05). However, histopathologic grading was not associated with the pRNFL and mGCIPL thicknesses.ConclusionAnti-SSB antibody positivity and ESR levels may be useful for predicting an abnormally reduced pRNFL or mGCIPL thickness in patients with pSS. Our results may provide clinical evidence to substantiate the association between aberrant autoimmunity and inner retinal changes in patients with pSS.

Optical Coherence Tomography Angiography Biomarkers of Retinal Thickness and Microvascular Alterations in Sjogren's Syndrome

“…The results of the multiple regression analysis showed that visual impairment was associated with retinal thinning. This is in agreement with previous studies demonstrating that the ganglion cell inner plexiform and retinal nerve fiber layers were thinner in patients with SS compared with healthy subjects ( 37 , 38 ). In healthy subjects, the inner RT is negatively correlated with age ( 39 ), which may be due to the loss of neurons, while the outer RT (especially RPE) may thicken with age ( 40 ).…”

Neurodegeneration in systemic lupus erythematosus: layer by layer retinal study using optical coherence tomography

“…Some studies evaluated subclinical retinal changes in other autoimmune systemic disorders using SD-OCT. A study in patients with rheumatoid arthritis revealed no significant changes in pRNFL or total foveal thickness compared to healthy controls [35]. On the other hand, patients with primary Sjogren's syndrome present a significant reduction in pRNFL as well as in macular GCL compared to healthy controls [36]. Patients with Behçet's disease also present significant thinning in the pRNFL [37].…”

Ocular microvascular damage in autoimmune rheumatic diseases: The pathophysiological role of the immune system

“…Specifically, a reduced thickness of the peripapillary retinal nerve fiber layer and of the macular ganglion cell-inner plexiform layer, measured by OCT, have been reported in association with SS-B positivity and with elevated erythrocyte sedimentation rate (ESR) in SS patients (Fig. 2B) [111,112].…”

“…Particularly, the pathomechanism of retinal ganglion cells (RGCs) involvement might be based on the binding of the autoantibodies to apoptotic RGCs, which impairs the clearance of these cells by eliciting proinflammatory responses as macrophage infiltration and increased production of IL-1, TNFα, ET-1 and NO (Fig. 2B) [112]. This interesting hypothesis is also supported by a recent study exploring the autoimmune aspects of eye glaucomatous changes, which have detected accumulation of type G immunoglobulins (IgG) and increased levels of proinflammatory cytokines in the human glaucomatous retina (Fig.…”