Retinal Microvasculature and Conjunctival Vessel Alterations in Patients With Systemic Lupus Erythematosus—An Optical Coherence Tomography Angiography Study

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.

Subclinical macular vessel density alterations in patients with juvenile systemic lupus erythematosus

“…It has been reported that retinopathy may be more common in patients with active inflammation. 20 No correlation between SLEDAI and retinal VD was found in the studies of Arfeen et al and Shi et al 14,21 We did not find this correlation in our study either. However, most of the patients included in the abovementioned studies were in the inactive or low-activity phase.…”

Subclinical microvascular changes in ANCA-vasculitides: the role of optical coherence tomography angiography and nailfold capillaroscopy in the detection of disease-related damage.

“…Our data support the utility of the OCT-A as a non-invasive tool to the early detection of retinal vascular abnormalities in AAV patients in whom both the cardiovascular and the complement-mediated in ammation might lead to retinal damages [51][52][53]. As reported from evidence in the literature, signi cant correlations occur between OCT-A abnormalities and disease activity in systemic autoimmune diseases as SLE suggesting that retinal capillary plexi may represent the "sentinel" of the microvascular network involved in systemic in ammatory disorders [29][30][31][32][33]. Accordingly, we documented in our AAV cohort that disease damage resulted directly related with the BVAS-disease activity as well as the disease duration: interestingly, vessel density from AAV patients resulted negatively related with disease-related damage (assessed by VDI) suggesting that a higher disease activity a greater microvascular injury.…”

“…Evidence from the literature supports the role of the optical coherence tomography angiography (OCT-A) as a non-invasive diagnostic tool for the early detection of subclinical retinopathy in systemic autoimmune diseases: accordingly, we recently documented, for the rst time, subclinical abnormalities in retinal microvascular network in patients with Systemic Lupus Erythematosus (SLE) by using OCT-A [29][30][31][32][33].…”

Macular microvasculature in patients with thyroid-associated orbitopathy compared to healthy individuals, foveal avascular zone area as a biomarker for disease activity

“…OCTA is a noninvasive, accessible, and relatively inexpensive method for monitoring macular blood ow. Previous studies have shown changes in macular blood ow in patients with hypertension, chronic kidney disease, hemodialysis, diabetes, and in ammatory diseases [2][3][4].…”