Retinal neurodegeneration in systemic lupus erythematosus: layer by layer retinal study using optical coherence tomography

Abstract

AbstractPurposeTo find early signs of retinal neurodegeneration by comparing the thickness of peripapillary retinal nerve fiber layer (pRNFL) and of all macular layers between systemic lupus erythematosus (SLE) patients without ophthalmologic manifestations and healthy controls. The effect of disease duration and systemic comorbidities was also studied.MethodsCross‐sectional study, in which retinal segmentation analysis with spectral domain‐optical coherence tomography (SD‐OCT) was performed. For pRNFL thickness, the global and six peripapillary sectors were determined. Each retinal layer thickness was calculated in the nine early treatment diabetic retinopathy study (ETDRS) subfields. Multiple regression analysis was performed.ResultsSixty‐eight eyes of 68 SLE patients and 50 eyes of 50 healthy controls were considered. pRNFL was significantly thinner in the SLE group globally (p = 0.026), in temporal superior (p = 0.007) and temporal (p = 0.037) sectors. Multivariable analysis in the SLE group revealed that chronic medication with antihypertensives, statins and anticoagulants were associated with a thinner pRNFL in some sectors (p < 0.05). SLE patients presented a significant thinning in the photoreceptor (PR) layer in five ETDRS areas (p < 0.05). Shorter disease duration was associated with greater photoreceptor thinning in all ETDRS subfields. Neuropsychiatric SLE, higher disease activity index and cardiovascular risk factors were associated with a thinner PR layer. No differences were observed in the remaining macular layers.ConclusionThis was the first study to perform OCT segmentation analysis of all retinal layers in SLE patients. These patients present a significant reduction in pRNFL and macular PR layer thickness. These differences were more pronounced in patients with poor systemic disease control, neuropsychiatric SLE and higher cardiovascular risk burden. Thus, there is evidence for the presence of early signs of retinal neurodegeneration in SLE.