Abstract
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.
Similar content being viewed by others
References
de Larrinoa IRFF (2015) What is new in systemic lupus erythematosus. Reumatol Clin 11(1):27–32
Semon HC, Wolff E (1933) Acute lupus erythematosus, with fundus lesions. Proc R Soc Med 27(2):153–157
Anders HJ, Fogo AB (2014) Immunopathology of lupus nephritis. Semin Immunopathol 36(4):443–459
Hasanreisoglu M, Gulpinar Ikiz GD, Kucuk H, Varan O, Ozdek S (2017) Acute lupus choroidopathy: multimodal imaging and differential diagnosis from central serous chorioretinopathy. Int Ophthalmol. https://doi.org/10.1007/s10792-016-0433-y
Giocanti-Auregan A, Grenet T, Rohart C, Badelon I, Chaine G (2013) Inaugural severe vaso-occlusive retinopathy in systemic lupus erythematosus. Int Ophthalmol 33(3):323–326
Pichi F, Sarraf D, Arepalli S et al (2017) The application of optical coherence tomography angiography in uveitis and inflammatory eye diseases. Prog Retin Eye Res 59:178–201
Chung CY, Tang HHY, Li SH, Li KKW (2017) Differential microvascular assessment of retinal vein occlusion with coherence tomography angiography and fluorescein angiography: a blinded comparative study. Int Ophthalmol. https://doi.org/10.1007/s10792-017-0570-y
Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725
Ghasemi Falavarjani K, Iafe NA, Hubschman JP et al (2017) Optical coherence tomography angiography analysis of the foveal avascular zone and macular vessel density after anti-VEGF therapy in eyes with diabetic macular Edema and retinal vein occlusion. Invest Ophthalmol Vis Sci 58(1):30–34
Hannouche D, Korobelnik JF, Cochereau I et al (1995) Systemic lupus erythematosus with choroidopathy and serous retinal detachment. Int Ophthalmol 19(2):125–127
Vianna RN (1999) Parafoveal arteriolar obstruction after ocular trauma in a patient with systemic lupus erithematosus. Int Ophthalmol 23(2):111–114
Rizos T, Siegelin M, Hähnel S, Storch-Hagenlocher B, Hug A (2009) Fulminant onset of cerebral immunocomplex vasculitis as first manifestation of neuropsychiatric systemic lupus erythematosus (NPSLE). Lupus 18(4):361–363
Arfeen SA, Bahgat N, Adel N et al (2020) Assessment of superficial and deep retinal vessel density in systemic lupus erythematosus patients using optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol. https://doi.org/10.1007/s00417-020-04626-7
Conigliaro P, Cesareo M, Chimenti MS et al (2019) Evaluation of retinal microvascular density in patients affected by systemic lupus erythematosus: an optical coherence tomography angiography study. Ann Rheum Dis 78(2):287–289
Barile-Fabris L, Hernández-Cabrera MF, Barragan-Garfias JA (2014) Vasculitis in systemic lupus erythematosus. Curr Rheumatol Rep 16(9):440
Heravian J, Saghafi M, Shoeibi N et al (2011) A comparative study of the usefulness of color vision, photostress recovery time, and visual evoked potential tests in early detection of ocular toxicity from hydroxychloroquine. Int Ophthalmol 31(4):283–289
Pichi F, Morara M, Veronese C, Ciardella AP (2017) The overlapping spectrum of flat irregular pigment epithelial detachment investigated by optical coherence tomography angiography. Int Ophthalmol. https://doi.org/10.1007/s10792-017-0547-x
Conigliaro P, Triggianese P, Draghessi G et al (2018) Evidence for the Detection of Subclinical Retinal Involvement in Systemic Lupus Erythematosus and Sjögren Syndrome: A Potential Association with Therapies. Int Arch Allergy Immunol 177(1):45–56
Fouad SA, Esmat Mahmoud Ali SM, Rezk Alnaggar ARL et al (2019) Structural retinal assessment using optical coherence tomography and fundus fluorescein angiography in systemic lupus erythematosus patients. J Clin Rheumatol. https://doi.org/10.1097/RHU.0000000000001162
Funding
No funding was received for the current Review.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The Authors have none to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Pichi, F., Woodstock, E., Hay, S. et al. Optical coherence tomography angiography findings in systemic lupus erythematosus patients with no ocular disease. Int Ophthalmol 40, 2111–2118 (2020). https://doi.org/10.1007/s10792-020-01388-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10792-020-01388-3