Preclinical ocular changes in systemic lupus erythematosus patients by optical coherence tomography

Abstract

Objectives The aim of the present study was to detect preclinical changes in SLE patients in retinal microvascularization or retinal and optical nerve structure by optical coherence tomography. Methods This cross-sectional, single-center study aimed to describe structural changes (macular and retinal nerve fiber layer [RNFL] thickness) by structural spectral-domain optical coherence tomography (SD-OCT) and perifoveal vascular (vascular density [VD] and perfusion [VP] and foveal avascular zone [FAZ] structural parameters) findings by OCT-angiography (OCTA) in 78 SLE patients and 80 healthy volunteers. In addition, we analyzed their association with clinical and laboratory parameters, medications received, disease duration and SLE activity and damage. Results Structural parameters by SD-OCT and perifoveal vascular parameters by OCTA were decreased in SLE patients compared with controls. OCTA parameters (VD, VP and FAZ circularity) and macular thickness were also decreased in patients with longer disease duration (>10 years). The presence of antiphospholipid antibodies was associated with a decreased RNFL thickness, mainly in the inferior quadrants. Patients developing antiphospholipid syndrome also showed decreased RNFL thickness and OCTA flow changes. SD-OCT and OCTA results were not associated with disease activity. Foveal structural parameters were lower in patients with higher damage score. Conclusion SD-OCT and OCTA can detect preclinical structural and microcirculatory changes in SLE patients. Structural and perifoveal vascular macular changes in SLE patients are related with disease duration. Macular structural parameters were impaired in patients with higher disease damage. Antiphospholipid syndrome seems to be associated with preclinical damage of the optic nerve and impairment of the perifoveal microvasculature.

New proposal for a multimodal imaging approach for the subclinical detection of hydroxychloroquine-induced retinal toxicity in patients with systemic lupus erythematosus

“…Patients with SLE showed significant thinning of the central macular thickness and retinal nerve fibre layer thickness compared with healthy controls. Furthermore, patients with SLE had significantly decreased vascular density and vascular perfusion when compared with controls, while the area of the foveal avascular zone did not differ between them 9. In the present analysis, all quantitative results from SD-OCT and OCTA showed no statistically significant differences between the two groups of hydroxychloroquine duration for any of the parameters analysed.…”

“…Regarding quantitative macular measurements, we have recently reported the differences between patients with SLE and controls in SD-OCT and OCTA parameters 9. Patients with SLE showed significant thinning of the central macular thickness and retinal nerve fibre layer thickness compared with healthy controls.…”

“…En face optical coherence tomography ( en face OCT) is a novel retinal imaging technique that has demonstrated the ability to detect reflectivity changes in cases of photoreceptor defects and assess the extent of retinopathy in a single image 8. In addition, OCT angiography (OCTA) can detect decreased vascular density in the capillary plexus layer and has been proposed as a potential additional parameter of retinal toxicity 9. These emerging techniques offer superior visualisation of the macular region, enabling identification of subclinical disease and detection of possible toxic alteration before irreversible damage occurs.…”

Microvasculature alterations of peripapillary retina and macula in systemic lupus erythematosus patients without ocular involvement by optical coherence tomography angiography

“…More and more researchers are using OCTA to study the fundus microvascular changes in SLE patients. [8][9][10][11][12][13][14][22][23][24][25][26][27][28][29][30] However, many researchers have found inconsistent results (Table 5). 8,11,13,26,27 In this study, we first evaluated the alterations of pVD in a circular area of F2.5 mm, F3.5 mm, and F5.0 mm, respectively.…”

“…21 Many studies have found that in SLE patients, the vessel densities (VD) in the inner retina has significant decreases accompanied with retinal nerve fiber layer (RNFL)/GCIPL. [22][23][24] Pelegrin et al 22 mentioned that different treatment modalities (e.g., continuous low-dose glucocorticoid treatment and prolonged HCQ treatment) were associated with decreased central macula and retinal microcirculation. Dias-Santos et al 24 demonstrated that SLE patients presented early signs of retinal neurodegeneration, as evidenced by a reduction in the photoreceptor layer and peripapillary retinal nerve fiber layer, which were more pronounced in patients with higher cardiovascular risk burden or neuropsychiatric involvement.…”