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Graefe's Archive for Clinical and Experimental Ophthalmology

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01-10-2020 | Systemic Lupus Erythematosus | Medical Ophthalmology

Altered microvascular density in patients with systemic lupus erythematosus treated with hydroxychloroquine—an optical coherence tomography angiography study

Authors: Nataša Mihailovic, Martin Dominik Leclaire, Nicole Eter, Viktoria C. Brücher

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 10/2020

Abstract

Purpose

To evaluate the retinal microvascular density using optical coherence tomography angiography (OCTA) in patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine (HCQ).

Methods

Nineteen eyes of 19 patients with SLE (study group) without HCQ retinopathy and 19 eyes of 19 healthy subjects (control group) were included in this study. The study group was divided into patients using HCQ for > 5 years (high-risk group) and < 5 years (low-risk group). The VD data of the 3 × 3 mm OCT angiogram of the superficial capillary plexus (SCP) and the choriocapillaris (VD-CC), the foveal avascular zone (FAZ) area and the central retinal thickness (CRT) were extracted and analyzed.

Results

VD in the en face SCP was significantly reduced in the high-risk group and the low-risk group compared with that in the control group (p < 0.001, p = 0.001) and in the high-risk group compared with the low-risk group (p = 0.007). Correlation analysis between the cumulative dose of HCQ and the VD of the study group revealed a negative correlation, but no statistical significance (p = 0.074). However, a significant positive correlation was observed for the low-risk group (p = 0.035). In patients with SLE, VD-CC was lower (p = 0.042) and the FAZ area larger (p = 0.019). CRT showed no difference between the groups (p = 0.183).

Conclusion

In this study, SLE patients showed a reduced VD in both groups. In patients treated with HCQ < 5 years, HCQ might have a protective effect on retinal microvasculature. Analysis of retinal microvascular density using OCTA could be useful in the diagnosis and monitoring of vascular alteration in patients with SLE.

Kuhn A, Bonsmann G, Anders H-J et al (2015) The diagnosis and treatment of systemic lupus erythematosus. Dtsch Ärztebl Int 112:423–432. https://doi.org/10.3238/arztebl.2015.0423CrossRefPubMedPubMedCentral

Silpa-archa S, Lee JJ, Foster CS (2016) Ocular manifestations in systemic lupus erythematosus. Br J Ophthalmol 100:135–141. https://doi.org/10.1136/bjophthalmol-2015-306629CrossRefPubMed

Marmor MF, Kellner U, Lai TYY et al (2016) Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 Revision). Ophthalmology 123:1386–1394. https://doi.org/10.1016/j.ophtha.2016.01.058CrossRefPubMed

Lee J-H, Kim S-S, Kim G-T (2013) Microvascular findings in patients with systemic lupus erythematosus assessed by fundus photography with fluorescein angiography. Clin Exp Rheumatol 31:871–876PubMed

Gharbiya M, Bozzoni-Pantaleoni F, Augello F, Balacco-Gabrieli C (2002) Indocyanine green angiographic findings in systemic lupus erythematosus choroidopathy. Am J Ophthalmol 134:286–290. https://doi.org/10.1016/S0002-9394(02)01477-0CrossRefPubMed

Spaide RF, Fujimoto JG, Waheed NK (2015) Image artifacts in optical coherence angiography. Retina Phila Pa 35:2163–2180. https://doi.org/10.1097/IAE.0000000000000765CrossRef

Goker YS, Atılgan CU, Tekin K et al (2019) The validity of optical coherence tomography angiography as a screening test for the early detection of retinal changes in patients with hydroxychloroquine Therapy. Curr Eye Res 44:311–315. https://doi.org/10.1080/02713683.2018.1545912CrossRefPubMed

Forte R, Haulani H, Dyrda A, Jürgens I (2019) Swept source optical coherence tomography angiography in patients treated with hydroxychloroquine: correlation with morphological and functional tests. Br J Ophthalmol. https://doi.org/10.1136/bjophthalmol-2018-313679

Conigliaro P, Cesareo M, Chimenti MS et al (2019) Evaluation of retinal microvascular density in patients affected by systemic lupus erythematosus: an optical coherence tomography angiography study. Ann Rheum Dis 78:287–289. https://doi.org/10.1136/annrheumdis-2018-214235CrossRefPubMed

10.

Alten F, Heiduschka P, Clemens CR, Eter N (2016) Exploring choriocapillaris under reticular pseudodrusen using OCT-Angiography. Graefes Arch Clin Exp Ophthalmol 254:2165–2173. https://doi.org/10.1007/s00417-016-3375-1

11.

Rice ME, Harris GT (2005) Comparing effect sizes in follow-up studies: ROC area, Cohen’s d, and r. Law Hum Behav 29:615–620. https://doi.org/10.1007/s10979-005-6832-7CrossRefPubMed

12.

Saygin D, Highland KB, Tonelli AR (2019) Microvascular involvement in systemic sclerosis and systemic lupus erythematosus. Microcirculation 26:e12440. https://doi.org/10.1111/micc.12440CrossRefPubMedPubMedCentral

13.

Dammacco R (2018) Systemic lupus erythematosus and ocular involvement: an overview. Clin Exp Med 18:135–149. https://doi.org/10.1007/s10238-017-0479-9CrossRefPubMed

14.

Conigliaro P, Cesareo M, Chimenti MS et al (2019) Take a look at the eyes in systemic lupus erythematosus: a novel point of view. Autoimmun Rev 18:247–254. https://doi.org/10.1016/j.autrev.2018.09.011CrossRefPubMed

15.

Wolf S, Arend O, Schulte K, Reim M (1992) Severe anaphylactic reaction after indocyanine green fluorescence angiography. Am J Ophthalmol 114:638–639. https://doi.org/10.1016/S0002-9394(14)74501-5CrossRefPubMed

16.

Bouman AC, de Kruijf D, Emmen JMA et al (2019) Systemic reaction to and interference with urine protein measurements after intravenous fluorescein injection. BMC Ophthalmol 19:261. https://doi.org/10.1186/s12886-019-1276-xCrossRefPubMedPubMedCentral

17.

Fenner BJ, Tan GSW, Tan ACS et al (2018) Identification of imaging features that determine quality and repeatability of retinal capillary plexus density measurements in OCT angiography. Br J Ophthalmol 102:509–514. https://doi.org/10.1136/bjophthalmol-2017-310700CrossRefPubMed

18.

Bulut M, Akıdan M, Gözkaya O et al (2018) Optical coherence tomography angiography for screening of hydroxychloroquine-induced retinal alterations. Graefes Arch Clin Exp Ophthalmol 256:2075–2081. https://doi.org/10.1007/s00417-018-4117-3CrossRefPubMed

19.

Wolfe F, Marmor MF (2010) Rates and predictors of hydroxychloroquine retinal toxicity in patients with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res 62:775–784. https://doi.org/10.1002/acr.20133CrossRef

20.

Schwartz MM, Roberts JL (1983) Membranous and vascular choroidopathy: two patterns of immune deposits in systemic lupus erythematosus. Clin Immunol Immunopathol 29:369–380. https://doi.org/10.1016/0090-1229(83)90040-5CrossRefPubMed

21.

Nguyen QD, Uy HS, Akpek EK et al (2000) Choroidopathy of systemic lupus erythematosus. Lupus 9:288–298. https://doi.org/10.1191/096120300680199024CrossRefPubMed

22.

Dias-Santos A, Tavares Ferreira J, Pinheiro S et al (2019) Choroidal thickness changes in systemic lupus erythematosus patients. Clin Ophthalmol Auckl NZ 13:1567–1578. https://doi.org/10.2147/OPTH.S219347CrossRef

23.

Ahn SJ, Ryu SJ, Lim HW, Lee BR (2019) Toxic effects of hydroxychloroquine on the choroid: evidence from multimodal imaging. Retina Phila Pa 39:1016–1026. https://doi.org/10.1097/IAE.0000000000002047CrossRef

24.

Mihailovic N, Eter N, Alnawaiseh M (2019) Foveal avascular zone and OCT angiography. An overview of current knowledge. Ophthalmol 116:610–616. https://doi.org/10.1007/s00347-018-0838-2CrossRef

Title: Altered microvascular density in patients with systemic lupus erythematosus treated with hydroxychloroquine—an optical coherence tomography angiography study
Authors: Nataša Mihailovic
Martin Dominik Leclaire
Nicole Eter
Viktoria C. Brücher
Publication date: 01-10-2020
Publisher: Springer Berlin Heidelberg
Keywords: Systemic Lupus Erythematosus
Angiography
Hydroxychloroquine
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 10/2020
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-020-04788-4

At a glance: The STEP trials

Springer Medicine

Altered microvascular density in patients with systemic lupus erythematosus treated with hydroxychloroquine—an optical coherence tomography angiography study

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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