Ocular immune reactants in patients dying with systemic lupus erythematosus

Immunopathologic studies were performed on ocular tissue obtained at autopsy in five patients with systemic lupus erythematosus (SLE). The immunopathologic findings were correlated with histopathologic and clinical features of SLE. Immune reactants were demonstrated by direct immunofluorescence in all patients in a granular pattern suggesting immune complex aggregates; control ocular tissues from four patients without SLE were negative. Ultrastructural studies demonstrated corresponding electron-dense aggregates in a majority of samples. Histologic and gross anatomic evidence of inflammation were generally more focal and less frequent than the distribution of immune reactants. Most of the immune deposits were localized in the walls of blood vessels of the conjunctiva, ciliary body, retina, choroid, and sclera. Diffuse deposits were also found in association with basement membranes in ciliary body (two of five patients) and along the epithelial basement membrane in the cornea (two of five). Immune deposits in peripheral nerves of the ciliary body and conjunctiva in one patient with visual symptoms contained immunoglobulins A and E. The most intense and widespread ocular immune deposits were observed in patients with persistently increased serologic and clinical activity of their systemic disease. These results suggest a role for immune complex localization in the pathogenesis of the ocular lesions of SLE.