Background Systemic Lupus Erythematous (SLE) and Sjögren Syndrome (SS) are autoimmune diseases that may exhibit several manifestations including an ocular involvement. Ocular involvement may be underestimated or be subclinical since current treatments as hydroxycloroquine and steroid may exert both beneficial and side effects on eyes.
Objectives To assess the eye involvement in patients affected by autoimmune diseases as SLE and SS.
Methods 48 patients affected by autoimmune diseases (29 SLE, 19 SS) without an active eye involvement were prospectively and consecutively enrolled. Morphological and functional eye assessment included: complete ophthalmogical examination, Spectral Domain Optical Coherence Tomography examination, fundus perimetry (FP), standard automated perimetry (SAP). 25 age and sex-matched healthy controls (HC) were also evaluated.
Results SS patients displayed a reduction of mean retinal thickness in the posterior pole compared with HC and SLE (p=0.0003 and p=0.03, Fig.1A). This reduction was demonstrated in superior and inferior hemifield compared with HC (p=0.001 and p=0.007) and in superior hemifield compared with SLE (p=0.01) (Fig.1B-C). The FP mean differential sensitivity in SLE and SS patients was reduced compared with HC (p<0.0001 and p=0.001, Fig.1D). The FP mean defect values in SLE and SS patients were higher than HC (p<0.0001 and p=0.03, Fig.1E). A negative correlation was demonstrated in SLE between age and FP mean differential sensitivity (p=0.0005, r= -0.7). FP alteration in SLE was prevalent in those patients that were not on steroid treatment. In SS a higher proportion of patients with alteration in FP received a cumulative hydroxycloroquine dose higher than 1000g (p=0.02). The SAP demonstrated in SLE and SS patients a significant increase of the mean defect (MD) and the pattern standard deviation (PSD) compared with HC (MD: p=0.001 and p=0.01, PSD: p=0.02 and p=0.0002; Fig.1F-G). Visual field index (VFI) values were reduced in both SLE and SS patients compared with HC (p<0.0001 for both comparisons, Fig.1H). SLE patients with kidney involvement displayed a significant increase of the MD and the PSD compared with those without kidney involvement (p=0.04 and p=0.01, respectively). Likewise, VFI values were reduced in SLE with nephritis compared with that in patients without a kidney involvement (p=0.04).
Conclusions In a small cohort of patients with autoimmune diseases without an overt active eye involvement a morphological alteration of the retinal posterior pole and functional impairment was demonstrated suggesting a subclinical involvement thatmight be concealed by the treatment.
Disclosure of Interest None declared