Background: Retinal involvement in systemic lupus erythematosus (SLE) and Sjögren syndrome (SS) may be subclinical and thus underdiagnosed. Objectives: We aimed at evaluating morphological and functional visual abnormalities in a cohort of SLE and SS patients in the absence of an overt clinical visual impairment. We also investigated potential associations between retinal disorders and disease activity, organ involvement, and treatment with steroid and/or hydroxychloroquine. Methods: The study comprised 42 SLE and 36 primary SS patients and 76 healthy controls (HC). Ophthalmological examination, standard automated perimetry, spectral-domain optical coherence tomography, and fundus perimetry were performed. Results: Retinal thickness of the posterior pole was not different between SLE and HC groups, but it was reduced in the SS group compared with both the HC and the SLE group. In SLE and SS patients, mean defect and pattern standard deviation by standard automated perimetry were higher than in HC. Visual field index values were lower in both SLE and SS patients than in HC. SLE patients with nephritis displayed increased mean defect and pattern standard deviation and reduced visual field index values compared to patients without nephritis. In SLE and SS patients, fundus perimetry differential sensitivity was reduced, and mean defect values were higher than in HC. Disturbances in fundus perimetry in the SLE group were more prevalent in steroid-naïve patients and in SS patients who received a cumulative hydroxychloroquine dose > 1,000 g. Conclusions: Functional eye impairment was demonstrated in SLE patients, possibly associated with kidney involvement. In SLE, corticosteroids might exert a protective role. Morphological alterations and functional impairment were detected in SS patients, which may be linked to hydroxychloroquine toxicity.

BackgroundPsoriatic Arthritis (PsA) is a chronic inflammatory arthritis typically often associated to several comorbidities. The presence of eye involvement in terms of uveitis is well known in PsA patients while retinal abnormalities and dry eye need to be characterisedObjectivesThe aim of the study was to analyse subclinical retinal abnormalities and dry eye in a cohort of PsA patients who were naïve to biologic treatmentsMethodsIn a prospective cross-sectional study, consecutive PsA patients without clinical eye involvement were enrolled (time frame January 2017-December 2017). Joint disease activity and ESR and CRP were measured. Functional and morphological eye assessment included: complete ophthalmological examination, ocular surface disease index (OSDI), Schirmer test, BUT, spectral-domain optical coherence tomography (SD-OCT), standard automated perimetry (SAP, measured as mean defect – MD – and pattern standard deviation – PSD), and fundus perimetry (FP). Data were compared to findings from the eyes of 24 age/sex matched healthy controls (HC).ResultsA total of 58 eyes from 29 PsA patients (21 women and 8 men; age 52.7±13.3 years) and 48 eyes from HC (14 women and 10 men; age 47.6±15 years) were evaluated.Overall, most of the PsA patients showed a normal Schirmer test, with the exclusion of three patients (10.3%). PsA patients showed abnormal OSDI in 55.2% and lower BUT in compared to HC (p<0.001, Fig.1A). ESR resulted positively correlated with OSDI (p<0.001, r=0.6, Fig.1B), and negatively related with Schirmer test (p=0.005, r=−0.5, Fig.1C) and BUT (p=0.04, r=−0.4, Fig.1D). In the PsA group, SAP tests showed a lower MD (p<0.0001) and a higher PSD (p=0.0043) in comparison with the HC. The latter PSD analysis resulted positively correlated with ESR (p=0.01; r=0.5) and CRP values (p=0.001; r=0.4). FP mean differential sensitivity and FP mean defect values were lower in PsA patients with respect to HC (p<0.0001 for both the comparisons, figure 1E-F) and resulted negatively correlated with the age (p=0.03 r=−0.4 for both the correlations, figure 1G-H). SD-OCT in the posterior pole (superior and inferior hemifields) did not reveal differences for the mean retinal thickness between PsA patients and HC.ConclusionsIntriguingly, an impairment in quality of tear film in PsA patients was observed compared to HC. The correlation between ESR and dry eye tests may be explained with a potential relationship between systemic inflammation and sicca syndrome.Interestingly, PsA patients showed a retinal functional impairment by reduced retinal sensitivity measured by MD, FP mean differential sensitivity and FP mean defect values.To our knowledge this is the first study investigating eye function and morphology in PsA patients. Further studies are needed to confirm and explain these results.Disclosure of InterestNone declared

BackgroundSystemic Lupus Erythematous (SLE) and Sjögren Syndrome (SS) are autoimmune diseases that may exhibit several manifestations including an ocular involvement. Ocular involvement may be underestimated or be subclinical since current treatments as hydroxycloroquine and steroid may exert both beneficial and side effects on eyes.ObjectivesTo assess the eye involvement in patients affected by autoimmune diseases as SLE and SS.Methods48 patients affected by autoimmune diseases (29 SLE, 19 SS) without an active eye involvement were prospectively and consecutively enrolled. Morphological and functional eye assessment included: complete ophthalmogical examination, Spectral Domain Optical Coherence Tomography examination, fundus perimetry (FP), standard automated perimetry (SAP). 25 age and sex-matched healthy controls (HC) were also evaluated.ResultsSS patients displayed a reduction of mean retinal thickness in the posterior pole compared with HC and SLE (p=0.0003 and p=0.03, Fig.1A). This reduction was demonstrated in superior and inferior hemifield compared with HC (p=0.001 and p=0.007) and in superior hemifield compared with SLE (p=0.01) (Fig.1B-C). The FP mean differential sensitivity in SLE and SS patients was reduced compared with HC (p<0.0001 and p=0.001, Fig.1D). The FP mean defect values in SLE and SS patients were higher than HC (p<0.0001 and p=0.03, Fig.1E). A negative correlation was demonstrated in SLE between age and FP mean differential sensitivity (p=0.0005, r= -0.7). FP alteration in SLE was prevalent in those patients that were not on steroid treatment. In SS a higher proportion of patients with alteration in FP received a cumulative hydroxycloroquine dose higher than 1000g (p=0.02). The SAP demonstrated in SLE and SS patients a significant increase of the mean defect (MD) and the pattern standard deviation (PSD) compared with HC (MD: p=0.001 and p=0.01, PSD: p=0.02 and p=0.0002; Fig.1F-G). Visual field index (VFI) values were reduced in both SLE and SS patients compared with HC (p<0.0001 for both comparisons, Fig.1H). SLE patients with kidney involvement displayed a significant increase of the MD and the PSD compared with those without kidney involvement (p=0.04 and p=0.01, respectively). Likewise, VFI values were reduced in SLE with nephritis compared with that in patients without a kidney involvement (p=0.04).ConclusionsIn a small cohort of patients with autoimmune diseases without an overt active eye involvement a morphological alteration of the retinal posterior pole and functional impairment was demonstrated suggesting a subclinical involvement thatmight be concealed by the treatment.Disclosure of InterestNone declared