Retinal microangiopathy in systemic lupus erythematosus

Area of Science:

• Ophthalmology
• Rheumatology
• Immunology

Background:

• Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect various organs, including the eyes.
• Ocular manifestations in SLE can be subtle and may not present with symptoms, making early detection challenging.
• Previous studies have focused on symptomatic ocular involvement, potentially overlooking subclinical vascular changes.

Purpose of the Study:

• To investigate subclinical retinal microvascular abnormalities in ambulatory patients with systemic lupus erythematosus (SLE) using fluorescein angiography.
• To determine the prevalence of retinal capillary changes in SLE patients without apparent ocular symptoms.
• To correlate these findings with the underlying autoimmune activity and potential past vasculitis.

Main Methods:

• A cohort of 50 ambulatory patients with moderately active or inactive SLE underwent comprehensive ocular examinations.
• Fluorescein angiography of the fundus was performed to visualize retinal vasculature.
• Ophthalmoscopic examinations were conducted to detect gross abnormalities.

Main Results:

• No ocular abnormalities were detected during standard ophthalmoscopic examination in any patient.
• Fluorescein angiography revealed microaneurysms in 9 patients (13 eyes) and retinal capillary dilatations with leakage in 6 patients (6 eyes).
• These subclinical vascular changes were observed despite the absence of ocular symptoms.

Conclusions:

• Subtle retinal microvascular changes, such as microaneurysms and capillary leakage, are detectable by fluorescein angiography in SLE patients even without ocular symptoms.
• These findings likely represent residual damage from previous episodes of acute vasculitis, possibly due to immune-complex deposition.
• Fluorescein angiography is a valuable tool for detecting subclinical ocular involvement in SLE, aiding in the comprehensive management of the disease.