[Ocular manifestations in patients with systemic lupus erythematosus and antiphospholipid syndrome]

Abstract

Introduction: Systemic lupus erythematosus (SLE) is a systemic disease of connective tissue with broad band of symptoms. It could be the reason for many organs and tissues impairment. Changes in eyes that occurr in SLE are not frequent, but can lead to severe impairment of sight including blindness.

Objectives: The aim of the work was to asses the frequency of eye changes among patients with SLE and SLE with antiphospholipid syndrome (APS). Another aim was to asses the association between antiphospholipid antibodies and ocular lesions.

Patients and methods: There were 75 patients enrolled with SLE, 26 of them ha APS. All of patients had a comprehensive ophthalmological and physical examination. Moreover biochemica analysis including lipid profile and glucose metabolism and serological markers of APS and SLE were performe

Results: Thirty-six patients complained of ophthalmologic disturbances (48%), with "dry eyes" being the most common symptom (20 patients). The reduced visual acuity was detected in 17 patients (22.6%). Conjunctivitis was found in 8 patients (10.67%), corneal involvement in 31 (41.3%), and sclera changes in 40 patients (53.3%). Changes in retina were found in 15 (20%) of patients, the most frequent were sub-retinal edema in the region of yellow spot. Changes in yellow spot were found in 8 patients; in 2 of them it was associated with dry degenerative changes, in 6 patients exudates with or without hemorrhages were found. Vascular changes including their lumen diameter were found in 33 patients (44%). In 4 patients there were changes in optical nerve disc. Schirmer's test was pathological in 43 patients (57.3%), but in only 4 patients Sjögren's syndrome was diagnosed. In the group of SLE patients intraocular pressure was significantly higher. The presence of anticardiolipin antibodies IgG class (aCL IgG) was associated with reduced visual acuity. The presence of lupus anticoagulant and anti-beta2, glycoprotein-I antibodies (anti-beta2GPI) was associated with conjunctive involvement. The presence of aCL IgM and anti-beta2GPI was associated with less frequent symptoms of eye dryness.

Conclusions: We found the following significant factors of the occurrence of eye involvement in our series of SLE patients: high activity of disease (conjuctiva, iris, uvea, retina, spot, vessels and optical nerve disc involvement), late diagnosis of SLE (retinopathy and conjuctive involvement), arterial hypertension (reduced visual acuity, cornea involvement, vessels involvement), age (reduced visual acuity, cornea involvement, retinopathy), glucose metabolism disorders (changes in optical nerve disc) and presence of anti-double stranded DNA antibodies (retinopathy).