Background/Purpose: Eye involvement in systemic lupus erythematosus (SLE) occurs in approximately one-third of patients, usually related to disease activity. An early diagnosis and treatment could prevent structural eye damage and visual acuity worsening in these cases. The purpose of the present study was t o describe macular vascular findings by optical coherence tomography angiography (OCT-A) in SLE patients related to the duration of disease and SLE activity/damage scores.

Methods: A cross-sectional, single-center study was carried out in 78 patients with SLE followed at Autoimmune Diseases and Ophthalmology Departments of the Hospital Clínic, Barcelona. As a control group, 80 sex and age-matched individuals were also analyzed. Clinical and immunological data, SLE activity and damage scores, and macular vascular parameters by OCT-A (CIRRUS ™ HD-OCT model 5000, Carl Zeiss Meditec, Inc., USA) were collected.

Results: Perifoveal vessel density in SLE patients was reduced compared to the control group (median 10.3 mm^-1[range 9.6-11.4] versus median 12.5 mm^-1 [range 11,7-13,7]) (p=0.001) as well as vascular perfusion proportion compared to controls (0.35 [0.34-0.37] versus 0.38 [0.37-0.39]) (p=0.001). Likewise, SLE patients with >10 years of disease  showed lower figures of vessel density (19.1 [18.2-20.2] versus 20.2 [19.7-20.9]) (p=0.04) and perfusion (0.34 [0.32-0.37] versus 0.36 [0.35-0.37]) (p=0.0017) compared to those with < 10 years of disease, respectively.

Patients with SLE damage index score >0 had worse values in area  (median 0.18 mm² [range 0.15-0.21] versus 0.27 mm² [range 0.23-0.31]) (p=0.002)  and perimeter foveal avascular zone (FAZ)  (median 1.84 mm²[range 1.70-2.12] versus 2.19 mm² [range 2.07-2.37]) (p=0.003). Likewise, patients with a clinical SLE disease activity index >4 showed a decrease in vessel density (14.6  mm^-1  [11.7-18.3] versus 17.6  mm^-1 [17.1-18.1])(p=0.02) and vascular perfusion (0.33  mm^-1  [0.23-0.44] versus 0.43 mm^-1  [0.42-0.45])(p=0.012).

Conclusion:

The macular capillary network of SLE patients shows lower vessel density and perfusion proportion than healthy controls. In addition, retinal vascular findings in SLE patients could be associated with the duration of disease, SLE activity, and damage index. Retinal vascular imaging explorations based on OCT-A could be of great interest in future studies in SLE in order to further clarify systemic implications of such characteristics.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/changes-in-macular-capillary-network-measured-with-optical-coherence-tomography-angiography-in-patients-with-systemic-lupus-erythematosus/