Session Title: Imaging I
Session Date/Time: Friday 18/09/2015 | 08:00-09:30
Paper Time: 08:24
First Author: : D.Tolba EGYPT
Co Author(s): : M. Nabih M. Salaheldin D. Elfayoumi
PURPOSE:Evaluation of systemic lupus erythmatosus retinopathy by fundus fluorescien angiography and correlating it with SLE disease activity, age of the patient, disease duration, treatment and associated hypertension.
Fundus fluorescein angiographies of 30 SLE patients were studied regardless of their visual symptoms. The patients satisfying the ARA (American rheumatology academy) criteria for the diagnosis of SLE were selected from the Rheumatology department of Kasr Al-Aini Hospital. Patients with history of diabetes, ocular trauma, surgery, or diseases were excluded.
It is a cross sectional observational analytical study.A history about SLE disease including its duration, activity according to SLEDAI (systemic lulpus erythamtosus disease activity index), associated hypertension and treatment was obtained. An ophthalmic history and an ophthalmological examination were done for each patient and it included: anterior segment examination, tear film assessment by Schirmer test, posterior segment examination through dilated pupil with slit lamp biomicroscopy using Volk +90 D lens and indirect ophthalmoscopy. Colored photography of fundus and fluorescein angiography were done with topcon set “TRC 50 IA” model. We ensured taking frames to the periphery by asking the patient to look at the extreme directions of gaze. The data were entered into a Microsoft Excel spreadsheet. Data were statistically described in terms of mean standard deviation ( SD), median and range, or frequencies (number of cases) and percentages when appropriate. Comparison between fundus and fluorescien results was done using McNemar test. Correlation between various variables was done using Spearman rank correlation equation. P values less than 0.05 was considered statistically significant. All statistical calculations were done using computer program SPSS (Statistical Package for the Social Science; SPSS Inc., Chicago, IL, USA) version 15 for Microsoft Windows.
Fifty nine eyes of thirty patients were included in this study. One eye could not be examined by FFA due to vitreous hemorrhage. The most common ocular manifestations were dryness (40%) followed by retinopathy (35%). Two patients showed cotton wool spots bilaterally (6.7%). Two eyes of one patient showed intraretinal haemorrhage with peripheral leakage (3.3%). Four eyes of two patients showed attenuated tortuous vessels (6.7%). Seven eyes of four patients (11.6%) showed peripheral leakage of fluorescien. Two of them were associated with intraretinal hemorrhage (3.3%) while five of them showed normal fundus examination (8.3%). Five eyes (8.3%) showed peripheral ischemia and capillary drop out. One eye showed neovasculrization. This patient showed in the other eye vitreous hemaorrhage with tractional retinal detachment (1.6%). Active chorioretinits (5%), RPE mottling (6.7%), disc vasculitis (5%) and disc hypoperfusion (1.7%) were also found in FFA. There was no significant difference in retinopathy between hypertensive and non hypertensives (p value is 0.54). Also there was no correlation between disease duration or patiens’ age and SLE retinopathy. However there was significant correlation between peripheral ischemia due to vasculitis and SLEDAI (p value = 0.008).
Retinal involvement is the most common ocular manifestation of SLE after keratoconjunctivitis sicca. Retinal vasculitis with focal leakage on FFA appears early in the development of lupus retinopathy, and is evident on FFA even with the appearance of normal fundus by routine examination. SLE retinopathy occurred independently on hypertenstion. No correlation between disease duration or patients’s age and retinopathy is found in our study. There is strong positive correlation between vasculitis and disease activity (SLEDAI).