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Retinal Thinning Predicts Neurodegeneration in Systemic Lupus Erythematosus

According to a new study, patients with systemic lupus erythematosus (SLE) have a progressive decline in the thickness of the peripapillary retinal nerve fiber layer (pRNFL), which could indicate early neurodegeneration.

Retinal Thinning Predicts Neurodegeneration in Systemic Lupus Erythematosus
Photo: Eye Examination | InStyleHealth

The researchers conducted a prospective cohort analysis of 68 previously diagnosed SLE patients (mean age 45.50±12.67 years, 85.3 percent women) who received a comprehensive ophthalmologic examination, which included spectral domain optical coherence tomography. These assessments were carried out over the course of two research visits (V1 and V2), separated by at least 12 months, and were accompanied with autoimmune tests.

Patients had been diagnosed with SLE for an average of 11 years and had been treated with hydroxychloroquine for an average of 5.3 years. All patients were clinically stable with modest disease activity at the time of enrollment and throughout the study.

The mean global pRNFL thickness at V1 was 96.59 ±10.68 µm, whereas it declined to 95.91 ±10.01 µm at V2 (p=0.006). pRNFL thinning in the temporal inferior area (141.85 ±19.89 to 140.48 ±19.79 µm; p=0.017), and to a lesser extent in the nasal inferior region (113.93 ±25.56 to 112.82 ±25.13 µm; p=0.053), appeared to be the primary cause of this decline.

Between V1 and V2, however, there were no significant differences in pRNFL thickness in the temporal superior, temporal, nasal, and nasal superior regions.

“These microstructural alterations could be linked to chronic low-grade inflammation, which leads to neuronal death, which are hallmarks of neurodegeneration,” the researchers speculated, noting that the pRNFL thinning is minor.

“Future studies with longer follow-up periods are needed to validate the progressive nature of retinal structural alterations and to relate them to structural and functional changes in central nervous system imaging,” the researchers concluded.

Source: Eye 2021;35:2771-2780

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