EARLY DETECTION OF NEUROVASCULAR ALTERATIONS AND THE IMPACT OF MEDICATION TREATMENT ON THE RETINA IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A Retrospective Cohort Study and Mendelian Randomization Analysis.

Abstract

This study aimed to evaluate early retinal structural and microvascular changes in patients with systemic lupus erythematosus (SLE) and to assess the impact of treatment on these alterations. This study used optical coherence tomography angiography to compare the retinal microstructure between patients with SLE and healthy controls. Patients with systemic lupus erythematosus were stratified into subgroups based on the treatment regimen they received: the hydroxychloroquine (HCQ)-glucocorticoid (GC) subgroup, the HCQ subgroup, and the GC subgroup. Mendelian randomization analysis was used to explore the causal relationship between HCQ/GC use and retinal vascular disorders. A retrospective analysis was conducted on data from 100 participants (59 patients with SLE and 41 controls). Patients with systemic lupus erythematosus showed reduced vascular density in superficial/deep capillary plexuses, radial peripapillary capillaries, choriocapillaris flow areas, and foveal 300- µ m wide vascular density (FD-300) ( P < 0.05). Inner limiting membrane-retinal pigment epithelium thickness in foveal/perifoveal regions was thinner in patients with SLE ( P < 0.05). Hydroxychloroquine or GC subgroups exhibited lower superficial capillary plexuses-vascular density, deep capillary plexuses-vascular density, FD-300, and choriocapillaris flow areas versus controls and HCQ-GC subgroup ( P < 0.05). The inner limiting membrane-retinal pigment epithelium thickness was thinnest in the HCQ monotherapy subgroup ( P < 0.05). The mendelian randomization analysis indicated that GC had an inhibitory effect on retinal vascular disorders (OR = 0.733, P = 0.037), whereas HCQ was not significantly correlated with these disorders. Optical coherence tomography angiography can detect early retinal changes in asymptomatic patients with SLE. Compared with monotherapy, combination therapy with HCQ and GCs is associated with less retinal damage.