Abstract
PurposeTo evaluate the retinal microvascular density using optical coherence tomography angiography (OCTA) in patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine (HCQ).MethodsNineteen eyes of 19 patients with SLE (study group) without HCQ retinopathy and 19 eyes of 19 healthy subjects (control group) were included in this study. The study group was divided into patients using HCQ for > 5 years (high-risk group) and < 5 years (low-risk group). The VD data of the 3 × 3 mm OCT angiogram of the superficial capillary plexus (SCP) and the choriocapillaris (VD-CC), the foveal avascular zone (FAZ) area and the central retinal thickness (CRT) were extracted and analyzed.ResultsVD in the en face SCP was significantly reduced in the high-risk group and the low-risk group compared with that in the control group (p < 0.001, p = 0.001) and in the high-risk group compared with the low-risk group (p = 0.007). Correlation analysis between the cumulative dose of HCQ and the VD of the study group revealed a negative correlation, but no statistical significance (p = 0.074). However, a significant positive correlation was observed for the low-risk group (p = 0.035). In patients with SLE, VD-CC was lower (p = 0.042) and the FAZ area larger (p = 0.019). CRT showed no difference between the groups (p = 0.183).ConclusionIn this study, SLE patients showed a reduced VD in both groups. In patients treated with HCQ < 5 years, HCQ might have a protective effect on retinal microvasculature. Analysis of retinal microvascular density using OCTA could be useful in the diagnosis and monitoring of vascular alteration in patients with SLE.
Highlights
Systemic lupus erythematosus (SLE) is an inflammatory autoimmune connective tissue disease with heterogenous disease expression and variable course of disease
optical coherence tomography angiography (OCTA) provides a three-dimensional visualization of choroidal and retinal microvascular layers as well as the possibility of quantification of the vessel density, which up to now has not been possible with fluorescein angiography (FA) and indocyanine green angiography (ICG) [6]
There was no significant difference in age between SLE patients and healthy controls (p = 0.630) and between patients of the high-risk group and the low-risk group (p = 0.857)
Summary
Systemic lupus erythematosus (SLE) is an inflammatory autoimmune connective tissue disease with heterogenous disease expression and variable course of disease. OCTA provides a three-dimensional visualization of choroidal and retinal microvascular layers as well as the possibility of quantification of the vessel density, which up to now has not been possible with FA and ICG [6]. Conigliaro et al showed a positive correlation between the cumulative dose of HCQ and VD in their patients [9]. These studies, either included only patients with a duration of HCQ treatment for > 5 years, did not differentiate between patients treated with HCQ for more and less than 5 years or included patients with other connective tissue diseases like rheumatoid arthritis. To the best of our knowledge, a VD analysis of the OCT angiogram of the choriocapillaris (VD-CC) in patients with SLE has not been described in the literature yet
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