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Response to: ‘OCTA, a sensitive screening for asymptomatic retinopathy, raises alarm over systemic involvements in patients with SLE’ by Mizuno et al
  1. Paola Conigliaro1,
  2. Massimo Cesareo2,
  3. Maria Sole Chimenti1,
  4. Paola Triggianese1,
  5. Claudia Canofari1,
  6. Gianluca Aloe2,
  7. Carlo Nucci2,
  8. Roberto Perricone1
  1. 1 Rheumatology, Allergology and Clinical Immunology, Department of 'Medicina dei Sistemi', University of Rome Tor Vergata, Rome, Italy
  2. 2 Ophthalmology Unit, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
  1. Correspondence to Dr Paola Conigliaro, Rheumatology, Allergology and Clinical Immunology, Department of 'Medicina dei Sistemi', University of Rome Tor Vergata, Rome 00133, Italy; paola.conigliaro{at}uniroma2.it

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We read with interest the letter titled ‘OCTA, a sensitive screening for asymptomatic retinopathy, raises alarm over systemic involvements in patients with SLE’ by Mizuno et al published in the Annals of the Rheumatic Diseases.1 In the letter, the authors pointed out that retinal vasculitis is an important manifestation of systemic lupus erythematosus (SLE), even if the patient is asymptomatic. Furthermore, they claim that patients with abnormal eye findings should be closely followed. We agree with Mizuno et al considering the non-invasive nature of optical coherence tomography angiography (OCTA), the reliability, and that high-resolution images of the retinal vasculature can be obtained approaching histology-level resolution. OCTA seems to be at least as good as invasive dye angiography in different retinal diseases, such as diabetic retinopathy and retinal vein occlusions.2 An important limitation of OCTA in the evaluation of retinal vascular diseases is the field of view; however, as the authors clearly demonstrated in their case report, this limitation will be likely overcome as commercial systems adopt wide field scan patterns. Actually, there is a strong need for 3D algorithms that will (at least partially) remove both noise and artefacts from OCTA. However, OCTA-based assessment of capillary density and morphology are very similar to histology-based studies, and in our study patients with SLE (without signs of retinopathy according to standard lupus retinopathy classification) displayed a reduced retinal microvascular density compared with normal subjects, in particular those with kidney involvement. Vessel density provided a quantitative metric of capillary network that correlated with age, best corrected visual acuity and clinical features as SLE disease activity.2 In patients with SLE, as in those with diabetic retinopathy or retinal vein occlusion, the need for frequent examination of retinal vasculature is crucial, mainly in light of therapeutic interventions, but fluorescein and indocyanine green angiography are impractical at that frequencies. Moreover, such angiographies are clearly contraindicated for individual with kidney failure or with a known allergy to fluorescein sodium dye or indocyanine green dye. OCTA may be useful especially for those patients with risk factors for retinopathy such as the presence of antiphospholipid antibodies, kidney or neuropsychiatric involvement.3 In this context, future studies should address first the sensitivity and specificity of OCTA to detect a vascular retinopathy in patients with SLE when compared with the gold standard technique such as the dye angiography. Then, it should be evaluated in longitudinal studies the predictive value of OCTA alterations in asymptomatic patients in relation to the development of retinal and/or systemic vasculitis. In agreement with data from the literature,4 OCTA has rapidly gained clinical acceptance and we believe that it will change the practice of the standard of care in patients with SLE. We welcome this report and all others that may appear in the future that will contribute to improve the research agenda in this field.

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Footnotes

  • PC and MC contributed equally.

  • Handling editor Josef S Smolen

  • Correction notice This article has been corrected since it published Online First. The author names have been updated.

  • Contributors All the authors contributed to the correspondence response.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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