scholarly journals Optical Coherence Tomography Angiography as a New Tool for Evaluation of the Subclinical Retinal Involvement in Patients with Systemic Lupus Erythematosus—A Review

2021 ◽  
Vol 10 (13) ◽  
pp. 2887
Author(s):  
Małgorzata Mimier-Janczak ◽  
Dorota Kaczmarek ◽  
Dawid Janczak ◽  
Radosław Kaczmarek
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Optical Coherence Tomography ◽  
Lupus Erythematosus ◽  
Optical Coherence Tomography Angiography ◽  
Diagnostic Process ◽  
Optical Coherence ◽  
Systemic Lupus ◽  
Asymptomatic Patients ◽  
Pubmed Database ◽  
Lupus Retinopathy

Knowing the proven relationship between lupus retinopathy and systemic changes and disease activity, it is crucial to find the possibility of early diagnosis of retinal changes at a subclinical level in order to provide faster medical intervention and protect the patient from irreversible changes in the eye and other organs. The aim of this review is an analysis of studies investigating early pathological changes in retinal vascularization obtained by optical coherence tomography angiography (OCTA) and their relationship to the systemic lupus erythematosus (SLE). A literature search was performed to identify all relevant articles, regarding detection of subclinical retinal changes using OCTA in systemic lupus erythematosus listed in PubMed database. Seven out of seven papers found showed a decrease in superficial capillary plexus in ocular asymptomatic patients diagnosed with SLE. A decrease in retinal vessel density measured by OCTA may be a good marker of SLE activity and poor prognosis. OCTA in a safe manner can give clinicians a new perspective on processes of vessel remodeling and answer the question of how SLE might impact the eye from a structural point of view. Adding OCTA to the standard diagnostic process of SLE patients, may detect systemic changes early and prevent further visual deterioration by stopping progression of lupus retinopathy.

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

2019 ◽  
Vol 3 (5) ◽  
pp. 283-288 ◽  
Author(s):  
Chirag Shah ◽  
Rami Gabriel ◽  
Sanjay Kedhar ◽  
Baruch Kuppermann ◽  
Mitul Mehta
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Optical Coherence Tomography ◽  
Lupus Erythematosus ◽  
Optical Coherence Tomography Angiography ◽  
Small Sample ◽  
Clinical Staging ◽  
Optical Coherence ◽  
Systemic Lupus ◽  
The Mean ◽  
Retinal Capillaries

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.

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

2021 ◽  
Vol 8 ◽  
Author(s):  
Wen-Qing Shi ◽  
Ting Han ◽  
Ren Liu ◽  
Qiang Xia ◽  
Tian Xu ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Optical Coherence Tomography ◽  
Lupus Erythematosus ◽  
Optical Coherence Tomography Angiography ◽  
Vessel Density ◽  
Vascular Density ◽  
Optical Coherence ◽  
Systemic Lupus ◽  
Clinical Indicators ◽  
Segmentation Analysis

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 &lt; 0.001). There was no significant difference in MIR, TMI, and MAR in the superficial layers between the SLE and healthy group (p &gt; 0.05). The DRL and DTMI (Deeper TMI) densities were decreased in the macular regions of SLE patients (p &lt; 0.05). In the hemispheric segmentation analysis, the superficial MIR was significantly decreased in the IL (inferior left) region of the SLE patients (p &lt; 0.05), and the deep MIR in the IR (inferior right) region was significantly reduced (p &lt; 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 &lt; 0.05). In the circular segmentation analysis, the deep MIR in the C1 and C3 regions was significantly reduced in SLE patients (p &lt; 0.05), while the superficial MIR density was decreased only in the C3 region (p &lt; 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 &lt; 0.0001). There was no significant correlation between vascular density and SLEDAI-2k (Systemic Lupus Erythematosus Disease Activity Index−2000) (P &gt; 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.

scholarly journals Ocular involvement in systemic lupus erythematosus patients: a paradigm shift based on the experience of a tertiary referral center

Lupus ◽  
2020 ◽  
Vol 29 (3) ◽  
pp. 283-289 ◽  
Author(s):  
A Dias-Santos ◽  
J Tavares Ferreira ◽  
S Pinheiro ◽  
J P Cunha ◽  
M Alves ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Optical Coherence Tomography ◽  
Lupus Erythematosus ◽  
Ocular Involvement ◽  
Optical Coherence ◽  
Systemic Lupus ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
The Mean

Objective To evaluate ocular involvement in a cohort of systemic lupus erythematosus (SLE) patients of a tertiary referral center and to compare the results with the existing literature. Methods Patients underwent a complete ophthalmological evaluation, including visual acuity, slit-lamp examination, fluorescein staining, Schirmer-I test, Goldmann applanation tonometry, fundoscopy, 10-2 automated threshold visual fields, fundus autofluorescence and spectral-domain optical coherence tomography to screen for hydroxychloroquine (HCQ) macular toxicity. Results A total of 161 patients (16 men and 145 women) were enrolled in this study. The mean age was 47.6 years and the mean disease duration was 11.5 years. Fifty patients (31.1%) had at least one ocular manifestation of SLE. The most frequent manifestation was dry eye syndrome (12.4%), immediately followed by cataracts (11.2%) and HCQ macular toxicity (11.2%). Among patients with HCQ maculopathy, two presented with an atypical spectral-domain optical coherence tomography pattern. Five patients (3.1%) presented with glaucoma, two patients (1.2%) presented with SLE retinopathy while only one presented with lupus choroidopathy (0.6%). Conclusions Compared with previous studies, we conclude there has been a significant reduction in disease-related ocular complications, particularly those associated with poor systemic disease control. On the other hand, drug and age-related complications are assuming a prominent role in the ophthalmic care of these patients.

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