Bilatéralisation à distance d’une occlusion de la veine centrale de la rétine associée à un syndrome des anti-phospholipides primaire

Ophthalmologic manifestations in primary antiphospholipid syndrome patients: A cross-sectional analysis of a primary antiphospholipid syndrome cohort (APS-Rio) and systematic review of the literature

OBJECTIVE

There is a broad spectrum of eye involvement in antiphospholipid syndrome (APS). The majority of descriptions are presented as case reports that include mostly APS patients secondary to systemic lupus erythematosus (SLE), with no compelling evidence in primary APS (PAPS). This study aimed to describe ocular manifestations in our well-defined PAPS cohort (APS-Rio) and then perform a systematic literature review (SLR) of ocular manifestations in patients with APS or positivity to aPL without SLE.

METHODS

We retrospectively analyzed PAPS patients followed at our outpatient clinics. All patients fulfilled Sydney APS classification criteria (2006). We evaluated them for ocular symptoms and previous ocular diagnoses. Antiphospholipid antibodies and clinical APS manifestations were compared between patients with and without ocular manifestations. For the SLR, electronic databases were searched up to November 2019.

RESULTS

We studied 105 PAPS patients; 90.5% were female and 56.2% were Caucasian. We found ocular manifestations in 37.1% of our cohort. Thrombosis was the main criteria manifestation (95.2%) and lupus anticoagulant was the most prevalent antibody. Ophthalmologic diagnoses were present in 7 patients, with 5 having retinal vessels thromboses. Amaurosis fugax was the leading complaint, present in 30 patients. In the univariate analysis, amaurosis fugax was related to livedo (p = 0.005), Raynaud's phenomenon (p = 0.048) and the presence of anticardiolipin antibody (≥40 GPL/MPL) (p = 0.041). Hemianopia was associated with arterial hypertension (p = 0.049). In the multivariate analysis, the only association found was between livedo and amaurosis fugax (OR 4.09, 95%CI 1.5-11.11, p = 0.006). Our SLR incorporated 96 articles of ocular manifestations in patients with PAPS or positivity to aPL without SLE. Ocular findings varied from 5 to 88%, including anterior and posterior segments, orbital and neuro-ophthalmologic changes.

CONCLUSION

There is little evidence on ocular manifestations in PAPS. We described an association between livedo and amaurosis fugax. Prospective studies are needed to promote the best treatment and avoid blindness in PAPS patients.

[Electrophysiological studies of the retina in antiphospholipid syndrome]

AIM

to evaluate the functional state of the retina in patients with antiphospholipid syndrome (APS) through different types of electroretinography (ERG).

MATERIAL AND METHODS

The total ERG (t-ERG), local macular ERG (m-ERG), and oscillatory potentials (OP) were recorded in 56 patients with verified APS.

RESULTS

In most patients with APS, ERG was of abnormal appearance, particularly, t-ERG was notable for reliably lower a- and b-wave amplitudes (70% of cases), m-ERG - for lower amplitudes and shorter latency (64% of cases). Pathological changes of t-ERG and m-ERG components were equally common in patients with and without retinal vascular occlusions. Linear dependence was established between the decrease in b-wave amplitude of subnormal t-ERG and the Vs value in the central retinal artery. A decrease in the OP index and OP configuration distortion were found in 82% of patients. At that, OP indices tended to be lower in patients from the retinal vascular occlusions group.

CONCLUSION

The use of different types of ERG enable detection of not only local, but also generalized retinal changes in APS. Regardless of the presence of retinal occlusion, APS patients show suppression of biopotential in most of cellular elements of the retina due to ischemia. Despite high visual acuity, the local macular potential gets significantly reduced in more than half of APS patients. Oscillatory potentials recording is a highly sensitive method for diagnosis of retinal ischmia in APS.