Retinal vasculitis in mixed connective tissue disease. A fluoroangiographic study

Area of Science:

• Ophthalmology
• Rheumatology
• Immunology

Background:

• Mixed connective tissue disease (MCTD), primary Sjögren's syndrome (SS), and systemic lupus erythematosus (SLE) are autoimmune disorders that can affect various organs, including the eyes.
• Ocular manifestations in these conditions can be subtle and may require advanced imaging techniques for detection.

Purpose of the Study:

• To investigate and compare ocular findings, particularly using retinal fluoroangiographic examinations (RFA), in patients with MCTD, primary SS, and SLE.
• To identify potential differences in the nature and prevalence of retinal vascular abnormalities among these three systemic autoimmune diseases.

Main Methods:

• Ophthalmologic examinations and RFA were performed on 20 consecutive patients with MCTD.
• Findings were compared with those from 18 consecutive patients with primary SS and 50 with SLE.
• RFA assessed capillary wall thickening, fluorescein leakage, microaneurysms, and other vascular changes.

Main Results:

• Six out of 20 MCTD patients (30%) exhibited abnormal RFA findings, including capillary wall thickening and progressive fluorescein leakage, indicative of subclinical vascular lesions.
• Ophthalmoscopy in MCTD patients revealed only one case of cotton wool spots, corresponding to ischemic areas on RFA.
• In contrast, 13 SLE patients showed RFA abnormalities (microaneurysms, capillary lesions, drusen), while only one primary SS patient had capillary leakage. No microaneurysms were observed in MCTD patients.

Conclusions:

• Retinal vascular abnormalities, particularly capillary wall thickening and leakage, are detectable via RFA in a significant subset of MCTD patients, often without overt ophthalmoscopic signs.
• The distinct RFA findings among MCTD, SLE, and SS patients suggest differences in the underlying immune complex formation and deposition characteristics.
• RFA is a valuable tool for detecting subclinical retinal vascular changes in systemic autoimmune diseases, aiding in understanding disease-specificpathophysiology.