Retinal alterations in evaluation of rheumatoid arthritis with chloroquine treatment: A new approach

Ocular markers of microangiopathy and their possible association with cardiovascular risk in patients with systemic inflammatory rheumatic diseases: a systematic review

Individuals with autoimmune rheumatic diseases (ARDs) are at a higher cardiovascular (CV) risk due to systemic inflammation, which contributes to endothelial dysfunction, atherosclerosis, and structural changes in the vessel walls. Along with traditional CV risk factors like dyslipidaemia, arterial hypertension, obesity, and impaired glucose metabolism, these patients have a severe prognosis with higher CV morbidity and mortality rates. To date, there is limited data on the optimal CV screening methods for individuals with ARDs, as conventional risk algorithms may underestimate the influence of chronic inflammation. In comparison to macrovascular assessment methods, such as carotid-femoral pulse wave velocity and carotid sonography, microvascular changes, which may precede macrovascular disease, have been less investigated. The ocular microvasculature reflects systemic vascular health and can reveal early signs of CV disease. Changes in retinal vessels have been linked to an increased long-term risk of CV mortality and ischemic stroke in longitudinal studies of the general population, such as the large Atherosclerosis Risk in Communities (ARIC) study. Additionally, various cross-sectional and follow-up studies in patients with ARDs have demonstrated associations between ocular vessel changes, traditional CV risk scores, and disease-related characteristics, suggesting a potential role for ocular assessments in CV risk screening. In this review work, research from 26 studies retrieved from the PubMed and Web of Science databases has been highlighted. Herein, we evaluate the techniques of retinal vessel analysis (RVA), optical coherence tomography angiography (OCT-A), spectral domain-OCT (SD-OCT), and retrobulbar color Doppler. Specifically, we examine the available data on their associations with key CV risk factors, systemic inflammation, surrogate CV markers, and traditional CV risk scores. Furthermore, we discuss their potential diagnostic value in both ARDs and the general population. Despite current limitations, such as small sample sizes and methodological heterogeneity, initial findings suggest that these techniques may provide valuable insights into microangiopathy and CV risk. Future research should focus on larger, well-designed longitudinal studies to establish their prognostic value and potential integration into clinical practice.

Inter-eye asymmetry of microvascular density in patients on hydroxychloroquine therapy by optical coherence tomography angiography

AIMS

To explore the inter-eye retinal microvascular density asymmetry of patients on hydroxychloroquine (HCQ) therapy through optical coherence tomography angiography (OCTA).

METHODS

40 subjects were enrolled in this cross-sectional study, including 20 systemic lupus erythematasus patients currently treated with HCQ (40 eyes) and 20 age- and sex-matched normal controls (NCs, 40 eyes). OCTA images were obtained to measure macular and peripapillary mircrovasculatures and microstructures, including vessel density, retinal nerver fiber layer thickness, and peripapillary ganglion cell-inner plexiform layer thickness. The absolute values of the difference between right and left eyes were taken as a measure of inter-eye asymmetry.

RESULTS

Macular whole image vessel density (wiVD-M) and perifoveal vessel density (pfVD) of superficial capillary plexus (SCP) were notably reduced in both the right and left eyes of the HCQ treatment group compared with NCs. Specifically, SLE patients treated with HCQ have higher inter-eye asymmetry of wiVD-M of SCP (2.28 ± 1.03 vs 1.27 ± 0.79, p < 0.01) and pfVD of SCP (2.55 ± 1.26 vs 1.78 ± 1.06, p = 0.04) compared with NCs. There were no significant differences in inter-eye asymmetry of structure parameters. Inter-eye asymmetry of wiVD-M of SCP (AUC = 0.80, p < 0.01) and pfVD of SCP (AUC = 0.71, p = 0.02) exhibited greater discrimination power.

CONCLUSION

SLE Patients treated with HCQ exhibited a notably higher inter-eye vessel density asymmetry compared to that of NCs. Thus, inter-eye vessel density asymmetry could be used to screen for HCQ retinal toxicity.

MICROVASCULATURE ALTERATIONS OF PERIPAPILLARY RETINA AND MACULA IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS WITHOUT OCULAR INVOLVEMENT BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY

PURPOSE

To evaluate microvasculature alterations of the peripapillary retina and macula and to assess whether the changes can detect preclinical retinopathy in systemic lupus erythematosus patients.

METHODS

Cross-sectional study of 32 systemic lupus erythematosus patients without retinopathy and 22 normal controls. Optical coherence tomography angiography was used to measure the microvasculature of the peripapillary retina and macula. Vessel densities (VD, %) and fractal dimensions of superficial capillary plexus (SCP) and deep capillary plexus were calculated.

RESULTS

Compared with controls, macular vessel densities of the whole image SCP (macular vessel density of SCP-wi) and macular vessel density of inferior SCP (macular vessel density of SCP-i) were significantly reduced in systemic lupus erythematosus patients ( P < 0.05). The peripapillary vessel densities (peripapillary vessel density [pVD]) of a 2.5-mm circle of SCP (pVD of SCP Φ2.5 ), pVD of SCP Φ3.5 , and pVD of inferior region of the inner circle of SCP (pVD of SCP-ii) were significantly reduced in patients treated with hydroxychloroquine >5 years. Macular vessel density of SCP-wi declined with age (β = -0.12; P < 0.01) and pVD of SCP-ii declined with hydroxychloroquine cumulative dose (β = -0.01; P < 0.01). Macular vessel density of SCP-i had the best discrimination power of 0.77 ( P < 0.01).

CONCLUSION

Systemic lupus erythematosus patients without ocular involvement had microvasculature alterations that were particularly evident in the SCP. Peripapillary retina microvasculature may be reduced in patients with longer hydroxychloroquine treatment.