Abstract
Purpose: To evaluate the conjunctival and fundus retinal vessel density in patients with systemic lupus erythematosus (SLE) with optical coherence tomography angiography (OCTA), and to investigate the relationship between vessel density and clinical indicators.Methods: Twelve patients with SLE (24 eyes) and 12 healthy controls (24 eyes) were recruited. OCTA was used to examine the superficial retina layer (SRL) and deep retina layer (DRL) in the macular retina and conjunctival capillary plexus of each eye. We calculated the density of the temporal conjunctival vessels, fundus microvascular (MIR), macrovascular (MAR) and total MIR(TMI) and compared the results in both groups. We used annular partitioning (C1–C6), hemispheric quadrants, and Early Treatment Diabetic Retinopathy Study partitioning (ETDRS) to analyze changes in the retinal vascular density. Correlation analysis was used to investigate the association between blood capillary density and clinical indicators.Results: OCTA results showed significant differences in the conjunctival microvascular density (p < 0.001). There was no significant difference in MIR, TMI, and MAR in the superficial layers between the SLE and healthy group (p > 0.05). The DRL and DTMI (Deeper TMI) densities were decreased in the macular regions of SLE patients (p < 0.05). In the hemispheric segmentation analysis, the superficial MIR was significantly decreased in the IL (inferior left) region of the SLE patients (p < 0.05), and the deep MIR in the IR (inferior right) region was significantly reduced (p < 0.05). In the ETDRS partitioning analysis, the superficial MIR in the inferior, right, and left subdivisions was significantly decreased in the SLE patients (p < 0.05). In the circular segmentation analysis, the deep MIR in the C1 and C3 regions was significantly reduced in SLE patients (p < 0.05), while the superficial MIR density was decreased only in the C3 region (p < 0.05). The conjunctival vascular density was negatively correlated with the STMI (Superficial TMI) (r = −0.5107; p = 0.0108) and DTMI (r = −0.9418, p < 0.0001). There was no significant correlation between vascular density and SLEDAI-2k (Systemic Lupus Erythematosus Disease Activity Index−2000) (P > 0.05).Conclusion: Clinically, patients with SLE and patients suspected of SLE should receive OCTA examination in a comprehensive eye examination to detect changes in ocular microcirculation at an early stage.
Highlights
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can cause changes in the whole body, including skin, joints, kidneys, and eyeballs
We observed no significant changes in SMIR, STMI, and SMAR in the superficial layers of SLE patients compared to the normal group (P > 0.05; Figure 3A)
Using the hemispheric segmentation method, we found that the IL region of superficial retinal vessels (P < 0.05; Figure 3B) and the IR region of deep retinal capillaries were significantly lower compared with healthy controls (P < 0.05; Figure 4B)
Summary
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can cause changes in the whole body, including skin, joints, kidneys, and eyeballs. 33–35% of SLE patients have ocular disease [1]. The incidence of ocular fundus lesions in SLE patients is about 15%. Previous studies have confirmed that visual impairment caused by SLE is often caused by retinal and optic neuropathy [2]. SLE can lead to serious visual impairment or even blindness if left untreated. A number of studies have suggested that SLE patients should receive eye examinations [5]. Eye lesions are an important part of SLE disease activity and have become one of the important indicators of lupus activity according to the British Isles Lupus Assessment Group [BILAG [6]]. Fundus examination and fundus fluorescence angiography (FFA) are the standard methods for posterior pathway evaluation of SLE patients. Some patients suffer from adverse reactions such as allergy, vomiting, and nausea due to the contrast agent
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