Título

OCULAR FINDINGS IN ASYMPTOMATIC PATIENTS WITH ANTIPHOSPHOLIPID SYNDROME SECONDARY TO SYSTEMIC LUPUS ERYTHEMATOSUS

Objetivo

To perform a multimodal ophthalmological evaluation, including the use of Optical Coherence Angiography (OCTA), in patients with APS secondary to SLE (APS/SLE) without complaints or history of eye problems and to compare the findings with SLE patients and healthy individuals - control group (CG).

Método

We performed a complete structural and functional ophthalmological evaluation using optical coherence tomography, OCTA and microperimetry exam in all participants.

Resultado

150 eyes / 75 asymptomatic subjects [APS/SLE (n=25), SLE (n=25) and CG (n=25)] were included. Ophthalmologic abnormalities occurred in 9 (36%) APS/SLE, 11 (44%) SLE and none of CG (p < 0.001). All patients were without disease activity with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K) ≤ 4. The most common retinal finding was Drusen-like deposits (DLDs) exclusively in APS/SLE and SLE (16% vs. 24%, p = 0.75) whereas severe changes occurred solely in APS/SLE [2 patients - 3 eyes with paracentral acute middle maculopathy (PAMM) and 1 patient with homonymous quadrantanopsia]. Half of patients affected by DLDs had no previous history of lupus nephritis. A trend of higher frequency of antiphospholipid antibodies (aPL) triple positivity (100% vs. 16%, p = 0.05) and higher mean values of adjusted Global Antiphospholipid Syndrome Score (aGAPSS) (14 ± 0 vs. 9.69 ± 3.44, p = 0.09) was observed in APS/SLE with PAMM vs. those without this complication.

Conclusão

We identified that ophthalmologic retinal abnormalities occurred in more than a 1/3 of asymptomatic SLE/APS and SLE. DLDs is the most frequent with similar frequencies in both conditions whereas PAMM occurred exclusively in APS/SLE patients. The possible association of latter condition with aPL triple positivity and high aGAPSS suggest these two conditions may underlie the retinal maculopathy. Our findings in asymptomatic patients reinforces the need for early surveillance in these patients.