Author: Gulfidan Bitirgen
Co-authors: Adem Kucuk, Mustafa Cagri Ergun
Abstract
Purpose: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which can affect multiple organ systems including central and peripheral nervous systems. Thinning of inner retinal layers have been considered as a sign of neurodegeneration. The purpose of this study was to assess the alterations in central inner retinal layers in patients with SLE.Setting/Venue: This cross-sectional comparative study was conducted at the Department of Ophthalmology, Necmettin Erbakan University Meram Medical Faculty Hospital, Konya, Turkey.
Methods: Thirty patients with a diagnosis of SLE and 24 control participants were included in the study. The Safety of Estrogens in Lupus Erythematosus National Assessment modification of the SLE Disease Activity Index (SELENA-SLEDAI) was used to assess the severity of disease activity. All participants underwent a complete ophthalmic evaluation including the automated quantification of inner retinal layer thicknesses by using spectral domain optical coherence tomography (SD-OCT, Spectralis, Heidelberg, Germany). Total macular volume (TMV), central macular thickness (CMT), and the mean thicknesses of nerve fiber layer (NFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), and total inner retinal layers (IRL) were measured at the fovea center (1 mm) and four quadrants (superior, inferior, nasal, temporal) of the parafoveal region (1-3 mm).
Results: The mean age was 36.9 ± 12.3 years in patients with SLE and 38.6 ± 12.4 years in the control group. No significant differences were present between the two groups in terms of age (P = 0.612) and gender (P = 0.771). The median time from the first diagnosis of SLE was 3.5 years and the median SELENA-SLEDAI score was 4.0. There were significant reductions in NFL, GCL and total IRL thicknesses at all quadrants of the parafoveal zone (P < 0.05 for all), IPL thickness at the superior (P = 0.009), temporal (P = 0.011) and nasal (P = 0.043) parafoveal regions, with no difference in TMV or CMT in patients with SLE compared to controls. In subgroup analysis, SLE patients with neuropsychiatric symptoms had reduced TMV (P = 0.013), and IRL thickness at the superior (P = 0.038) and nasal (P = 0.019) quadrants compared to those without neuropsychiatric symptoms. There was a significant inverse correlation between SELENA-SLEDAI score and INL thickness at the temporal quadrant (rho = -0.362; P = 0.049).
Conclusions: Evaluation with SD-OCT revealed significant thinning of macular inner retinal layers in patients with SLE, especially in patients having neuropsychiatric symptoms. The reduction in INL thickness was associated with the severity of disease activity. Further longitudinal investigations are required to better understand the association between retinal involvement and central neurodegeneration in SLE.
Financial Disclosure: The authors have no financial relationship to disclose.
