Subclinical Foveal Vasculopathy in Patients With Systemic Lupus Erythematosus Using Optical Coherence Tomography Angiography

Abstract

Purpose: This article identifies subclinical microvascular changes in systemic lupus erythematosus (SLE) patients using vascular perfusion densities derived from optical coherence tomography angiography (OCTA). Methods: A retrospective review was performed on individuals with SLE (10 eyes of 5 patients) and age-matched controls imaged with a spectral-domain OCT system (XR Avanti, Optovue, Inc). A split-spectrum amplitude-decorrelation algorithm (SSADA) generated OCTA of the superficial retinal capillaries, deep retinal capillaries, and foveal avascular zone (FAZ). Skeletonized OCTAs were used to create capillary vessel density (VD) values for each image. VD values were compared with clinical staging, and groups were compared using Kruskal–Wallis and Mann–Whitney tests. Results: Both the superficial (SCP) and deep capillary plexus (DCP) had a statistically significant decrease in VD in the SLE group when compared with the control group ( P < .05). The average VD ± SD for normal individuals in the 3 mm × 3 mm scans was 26.11 ± 1.2 and 37.45 ± 1.8 for the SCP and DCP, respectively. For SLE patients the mean ± SD was 18.46 ± 0.84 and 30.22 ± 1.5 for SCP and DCP, respectively. The mean FAZ was found to be 0.207 mm ± 0.02 for healthy controls and 0.350 mm ± 0.02 for SLE patients ( P < .001). Conclusions: In this paper we demonstrate a significantly enlarged FAZ and decreased VD in a small sample of patients with lupus. The SCP VD demonstrated a dose-response–type negative relationship with increased systemic lupus severity. Larger-sample, prospective studies may allow us to further characterize subclinical SLE pathology with OCTA, and OCTA may further provide a means for monitoring the severity or progression of other microvascular diseases.

Retinal vasospastic phenomenon in a known case of systemic lupus erythematosus

“…These findings have been reported as a sequelae to lupus retinopathy which is caused due to microvascular thrombosis and immune complex mediated vascular injury. [ 8 ] Hypothetically in the presence of a flow void on OCTA the dye in FFA should not perfuse the macula producing a clear area of capillary non-perfusion. However, we saw an ill-defined subtle hypofluorescence in the early and mid-phase persisting in the late phase.…”

“…[ 7 ] OCT Angiography has revealed enlarged foveal avascular zones and decreased vessel density. [ 8 ]…”