Ocular involvement in systemic lupus erythematosus patients: a paradigm shift based on the experience of a tertiary referral center

Author:

Dias-Santos A123ORCID,Tavares Ferreira J123,Pinheiro S4,Cunha J P13,Alves M5,Papoila A L356,Moraes-Fontes M Francisca378ORCID,Proença R910

Affiliation:

1. Department of Ophthalmology, Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal

2. Department of Ophthalmology, Hospital CUF Descobertas, Lisbon, Portugal

3. NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal

4. Autoimmune Disease Unit, Unidade de Doenças Auto-imunes/Serviço Medicina 3, Hospital de Santo António dos Capuchos, Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal

5. Epidemiology and Statistics Unit, Research Center, Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal

6. CEAUL (Center of Statistics and Applications), Lisbon University, Lisbon, Portugal

7. Autoimmune Disease Unit, Unidade de Doenças Auto-imunes/Serviço de Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal

8. Instituto Gulbenkian de Ciência, Oeiras, Portugal

9. Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

10. Faculty of Medicine, University of Coimbra, Coimbra, Portugal

Abstract

Objective To evaluate ocular involvement in a cohort of systemic lupus erythematosus (SLE) patients of a tertiary referral center and to compare the results with the existing literature. Methods Patients underwent a complete ophthalmological evaluation, including visual acuity, slit-lamp examination, fluorescein staining, Schirmer-I test, Goldmann applanation tonometry, fundoscopy, 10-2 automated threshold visual fields, fundus autofluorescence and spectral-domain optical coherence tomography to screen for hydroxychloroquine (HCQ) macular toxicity. Results A total of 161 patients (16 men and 145 women) were enrolled in this study. The mean age was 47.6 years and the mean disease duration was 11.5 years. Fifty patients (31.1%) had at least one ocular manifestation of SLE. The most frequent manifestation was dry eye syndrome (12.4%), immediately followed by cataracts (11.2%) and HCQ macular toxicity (11.2%). Among patients with HCQ maculopathy, two presented with an atypical spectral-domain optical coherence tomography pattern. Five patients (3.1%) presented with glaucoma, two patients (1.2%) presented with SLE retinopathy while only one presented with lupus choroidopathy (0.6%). Conclusions Compared with previous studies, we conclude there has been a significant reduction in disease-related ocular complications, particularly those associated with poor systemic disease control. On the other hand, drug and age-related complications are assuming a prominent role in the ophthalmic care of these patients.

Publisher

SAGE Publications

Subject

Rheumatology

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