Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Italy.
Ophthalmology Unit, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Italy.
Autoimmun Rev. 2019 Mar;18(3):247-254. doi: 10.1016/j.autrev.2018.09.011. Epub 2019 Jan 11.
Systemic Lupus Erythematosus (SLE) is a connective tissue disease that involves multiple organs. Ocular structures and visual pathways can be affected in SLE because of disease-related eye involvement or drug toxicity. All the part of the eye may be interested with an external, anterior involvement, responsible of the dry eye disease, or posterior (retina) and neuro-ophtalmic manifestations. Retinopathy in SLE is suggestive of high disease activity being a marker of poor visual outcome and prognosis for survival. The early diagnosis is thus the key to a better management and successful treatment. Antimalarial drugs are the cornerstone of SLE treatment and recently the American Academy of Ophthalmology updated the recommendations for hydroxychloroquine retinal toxicity screening which includes the standard automated visual fields and the spectral domain optical coherent tomography. More recently new imaging techniques have been investigated to assess retinal function and reveal subclinical eye involvement. In this review we focalize on the evidence of eye manifestations in SLE, the eye drug toxicity related to antimalarial agents and steroids, and the methods employed for the eye screening. Moreover, the future perspectives on new techniques, such as the optical coherence tomography angiography, are dissected giving new insights on evaluation of microvasculature of the retina and choroid in SLE.
红斑狼疮(SLE)是一种结缔组织疾病,涉及多个器官。由于疾病相关的眼部受累或药物毒性,眼部结构和视觉通路可能会受到影响。眼睛的所有部位都可能受到外部、前部的影响,导致干眼症,或后部(视网膜)和神经眼科表现。SLE 中的视网膜病变提示疾病活动度高,是视力预后不良和生存预后的标志。因此,早期诊断是更好管理和成功治疗的关键。抗疟药是 SLE 治疗的基石,最近美国眼科学会更新了羟氯喹视网膜毒性筛查的建议,包括标准自动视野和光谱域光学相干断层扫描。最近,还研究了新的成像技术来评估视网膜功能和发现亚临床眼部受累。在这篇综述中,我们重点关注 SLE 中的眼部表现、与抗疟药和类固醇相关的眼部药物毒性以及眼部筛查所采用的方法。此外,还探讨了新技术的未来前景,如光相干断层扫描血管造影术,为评估 SLE 中视网膜和脉络膜的微血管提供了新的见解。