Objective-To investigate the incidence of retinopathy in systemic lupus erythematosus (SLE) and to clarify its significance in relation to other clinical manifestations. Methods-A cross sectional study on lupus retinopathy was made in 69 patients with SLE. One expert ophthalmologist examined the ocular fundi of the lupus patients without any information of their disease state. Clinical and laboratory findings in the patients with retinopathy and those without were compared. Results-Retinopathy was found in 7/69 (10%) patients. The findings included haemorrhages, vasculitis, cotton wool spots, and hard exudates, all of which were considered to reflect vascular damage. Retinopathy was found to be associated with the presence of anticardiolipin antibody (p<0.05) and with central nervous system lupus (p<0.01). The patients with retinopathy had higher levels of serum creatinine than the patients without retinopathy (p<0.01). The disease activity of lupus, as assessed by the maximum SLE disease activity index (SLEDAI) score of the patients, was also significantly higher in the patients with retinopathy (p<0.03). Conclusion-Incidence of retinopathy in SLE was similar to that in previous reports and it may reflect tissue microangiopathy, particularly associated with vasculitis or anticardiolipin antibodies, or both.

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The authors report postoperative change in pupil diameter and pupil dynamics after phaco-emulsification-aspiration and intra-ocular lens implantation by comparing the operated eye and non-operated eye in 20 patients who received unilateral surgery. Miosis was noted in the operated eye throughout the postoperative period in the dark, and also in the light at an early stage after the operation. Both the maximal constriction velocity and maximal dilatation velocity of the light reflex decreased postoperatively, but the constriction velocity alone was accelerated 1 or 2 weeks after the operation. In the drug instillation test, pupillary responses to both neosynephrine and pilocarpine were decreased, indicating damage both to the dilator and sphincter muscles. Since no hypersensitivity of the pupil was noted, lesions in the axonal fibres and denervation were judged to be absent. Postoperative miosis is believed to be explained by irreversible damage to the dilator muscle, as well as by the transient effects of inflammatory substances.

Phacoemulsification-aspiration (PEA) followed by peripheral iridectomy was performed in 10 patients, and the dissected iris fragments were examined by electron microscopy. Organic changes such as cytoplasmic vacuolation and lamellar formation were observed in both the sphincter and dilator muscles of the pupil. No changes in the axons were detected. The same findings were observed when a simian eye was examined after PEA. These results indicate that PEA causes injury to iris muscles.

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