Altered microvascular density in patients with systemic lupus erythematosus treated with hydroxychloroquine—an optical coherence tomography angiography study

Abstract

Purpose To evaluate the retinal microvascular density using optical coherence tomography angiography (OCTA) in patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine (HCQ). Methods Nineteen eyes of 19 patients with SLE (study group) without HCQ retinopathy and 19 eyes of 19 healthy subjects (control group) were included in this study. The study group was divided into patients using HCQ for > 5 years (high-risk group) and < 5 years (low-risk group). The VD data of the 3 × 3 mm OCT angiogram of the superficial capillary plexus (SCP) and the choriocapillaris (VD-CC), the foveal avascular zone (FAZ) area and the central retinal thickness (CRT) were extracted and analyzed. Results VD in the en face SCP was significantly reduced in the high-risk group and the low-risk group compared with that in the control group (p < 0.001, p = 0.001) and in the high-risk group compared with the low-risk group (p = 0.007). Correlation analysis between the cumulative dose of HCQ and the VD of the study group revealed a negative correlation, but no statistical significance (p = 0.074). However, a significant positive correlation was observed for the low-risk group (p = 0.035). In patients with SLE, VD-CC was lower (p = 0.042) and the FAZ area larger (p = 0.019). CRT showed no difference between the groups (p = 0.183). Conclusion In this study, SLE patients showed a reduced VD in both groups. In patients treated with HCQ < 5 years, HCQ might have a protective effect on retinal microvasculature. Analysis of retinal microvascular density using OCTA could be useful in the diagnosis and monitoring of vascular alteration in patients with SLE.

Evaluation of subclinical retinal microvascular changes in systemic lupus erythematosus patients using optical coherence tomography angiography and its relationship with disease activity

“…While several SLE studies showed that the FAZ area was enlarged in SLE patients compared to the control group, two studies showed no change in the FAZ area in SLE patients, similar to our study. 16,23,24,25,32 (Table 6) In our study, although SCP VD in the foveal area was found to be lower in SLE patients than that in the HCs, the size and shape of the FAZ in the SCP area were not affected.…”

“…Some studies have investigated subclinical retinal involvement and VD in SLE. 10,12,16,20,[22][23][24][25][26] A brief literature review of OCTArelated findings in SLE patients is shown in Table 6. In our study, DCP VD was found to be significantly lower in SLE patients than in HCs in all areas except the perifoveal temporal area.…”

“…All patients treated with HCQ for more than 5 years. The HCQ group showed a reduction of the VD in the 1 mm central, in the nasal and temporal subfields of DCP and in the 1 mm central subfield of CC, an increased FAZ in the three (retinal superficial, middle, and deep) capillary plexuses, and a reduced foveal choroidal thickness Mihailovic et al 24 There were two groups as patients treated with HCQ≤5 and >5 years. There was a positive correlation between the cumulative dose of HCQ and the VD in patients with HCQ≤5 years.…”

Retinal Microcirculation Changes in Crohn’s Disease Patients under Biologics, a Potential Biomarker of Severity: A Pilot Study

“…The mechanisms of retinal microvascular changes in CD patients have never been studied. An enlargement of the FAZ has been described in pathologies causing retinal capillary ischemia such as diabetic retinopathy [29] and lupus erythematosus [20]. The microcirculatory damage observed in our population of CD patients may be explained by the inflammation and arthrosclerosis and prothrombotic state that the disease induces.…”

“…Altered retinal microcirculation has been described in active IBD [16], and increased arteriolar tortuosity has also been reported in IBD, probably due to systemic vascular damage [17]. In the same way, altered OCT-A findings were described in rheumatoid arthritis, another chronic systemic inflammatory disease with increased cardiovascular risk [18,19], and in lupus erythematosus, which is also associated with a high thrombotic risk [20]. The increased cardiovascular and prothrombotic risk in CD could be associated with a rarefaction of the retinal microcirculation, which can be observed in OCT-A by a decrease of the microvascular density or an enlargement of the central avascular zone [21].…”