Abstract
Knowing the proven relationship between lupus retinopathy and systemic changes and disease activity, it is crucial to find the possibility of early diagnosis of retinal changes at a subclinical level in order to provide faster medical intervention and protect the patient from irreversible changes in the eye and other organs. The aim of this review is an analysis of studies investigating early pathological changes in retinal vascularization obtained by optical coherence tomography angiography (OCTA) and their relationship to the systemic lupus erythematosus (SLE). A literature search was performed to identify all relevant articles, regarding detection of subclinical retinal changes using OCTA in systemic lupus erythematosus listed in PubMed database. Seven out of seven papers found showed a decrease in superficial capillary plexus in ocular asymptomatic patients diagnosed with SLE. A decrease in retinal vessel density measured by OCTA may be a good marker of SLE activity and poor prognosis. OCTA in a safe manner can give clinicians a new perspective on processes of vessel remodeling and answer the question of how SLE might impact the eye from a structural point of view. Adding OCTA to the standard diagnostic process of SLE patients, may detect systemic changes early and prevent further visual deterioration by stopping progression of lupus retinopathy.
Highlights
Systemic lupus erythematosus (SLE) is a chronic, systemic, autoimmune inflammatory connective tissue disease associated with the involvement of the majority of human organs, including eye vasculature [1]
Patients with kidney involvement displayed reduced parafoveal vessel density and parafoveal thickness compared with SLE patients without it, but this finding was not supported by the results presented by Işık et al, who have shown no difference between patients with SLE and kidney involvement and patients with SLE without kidney involvement in optical coherence tomography angiography (OCTA) parameters [21]
Should its early detection prove beneficial in terms of further rheumatological treatment of SLE, it might be reasonable to introduce OCTA as a standard diagnostic tool in ophthalmic examination for all SLE patients
Summary
Systemic lupus erythematosus (SLE) is a chronic, systemic, autoimmune inflammatory connective tissue disease associated with the involvement of the majority of human organs, including eye vasculature [1]. Retinopathy in SLE is the second most common ophthalmic manifestation after keratoconjunctivitis sicca and the most common ocular complication affecting visual acuity [4]. The incidence of retinopathy in SLE ranges from 7% to 26%, depending on the disease control and activity [5]. Its presence is a poor prognostic factor for both visual acuity and survival rate compared to patients without retinopathy. Affection of the posterior segment of the eye in the course of SLE may precede systemic symptoms and its detection may help in early diagnosis and prompt initiation of treatment [9]
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