Ocular involvement in systemic lupus erythematosus patients: a paradigm shift based on the experience of a tertiary referral center

Abstract

Objective To evaluate ocular involvement in a cohort of systemic lupus erythematosus (SLE) patients of a tertiary referral center and to compare the results with the existing literature. Methods Patients underwent a complete ophthalmological evaluation, including visual acuity, slit-lamp examination, fluorescein staining, Schirmer-I test, Goldmann applanation tonometry, fundoscopy, 10-2 automated threshold visual fields, fundus autofluorescence and spectral-domain optical coherence tomography to screen for hydroxychloroquine (HCQ) macular toxicity. Results A total of 161 patients (16 men and 145 women) were enrolled in this study. The mean age was 47.6 years and the mean disease duration was 11.5 years. Fifty patients (31.1%) had at least one ocular manifestation of SLE. The most frequent manifestation was dry eye syndrome (12.4%), immediately followed by cataracts (11.2%) and HCQ macular toxicity (11.2%). Among patients with HCQ maculopathy, two presented with an atypical spectral-domain optical coherence tomography pattern. Five patients (3.1%) presented with glaucoma, two patients (1.2%) presented with SLE retinopathy while only one presented with lupus choroidopathy (0.6%). Conclusions Compared with previous studies, we conclude there has been a significant reduction in disease-related ocular complications, particularly those associated with poor systemic disease control. On the other hand, drug and age-related complications are assuming a prominent role in the ophthalmic care of these patients.

Retinopathy in newly-diagnosed systemic lupus erythematosus: should we screen for ocular involvement?

“…The most common findings among patients with retinopathy were cotton-wool spots, retinal hemorrhage, and Roth spots, which is in line with previous studies [ 3 , 4 , 6 , 8 – 11 , 13 ]. All of these pathologies reflect vascular damage.…”

“…Seth et al reported similar findings, and also reported a higher incidence of autoimmune hemolytic anemia in SLE patients with retinopathy [ 7 ]. Similar to previous reports, we found that patients with retinopathy have lower C3 and C4 concentrations, and have higher levels of ANA and Anti-dsDNA, findings which indicate an antibody-mediated retinal damage pathogenesis [ 1 – 6 , 8 – 11 , 13 , 17 ]. Urine casts were also significantly more prevalent in patients with retinopathy.…”

“…The most important finding of this study is that 15.8% of newly-diagnosed SLE patients had evidence of retinopathy, as examined by an ophthalmologist. This is substantially higher than previous reports on ambulatory patients, but still lower than admitted patients with an active disease, in whom a prevalence of up to 50% has been reported [ 1 – 4 , 6 – 9 , 13 , 17 ].…”

“…While data is scarce and based on low-level evidence, approximately a third of SLE patients manifest ocular involvement [ 1 , 3 , 4 , 6 , 8 – 11 ]. Ocular manifestations of SLE might be a primary finding related to the disease pathophysiology (e.g., retinopathy), due to a secondary disorder (e.g., Keratoconjunctivitis sicca, associated Sjögren’s syndrome (SS)), or a complication of treatment (e.g., hydroxychloroquine toxicity, drug-induced optic neuritis).…”

“…Third, as is the case with hypertension and diabetic retinopathy, patients are not symptomatic at early stages of retinal involvement, and the diagnosis could only be made if the clinician is cognizant of such pathologies. Finally, treatment of posterior segment involvement is efficacious, especially if the lesions are diagnosed early [ 3 , 6 , 7 , 11 , 13 , 17 ]. Therefore, with the implications they have on the diagnosis, treatment, and prognosis of the disease, ocular manifestations of SLE merit further exploration.…”