Wide-field Optical Coherence Tomography Angiography Detects Alterations in the Early Retinal and Choroidal Microvasculature and Related Fundus Indicators in Patients with SLE.

OBJECTIVES: To investigate the alterations in retinal and choroidal microvasculature and related fundus indicators in patients with systemic lupus erythematosus (SLE) using wide-field optical coherence tomography angiography (OCTA). METHOD: SLE patients without retinopathy and healthy controls (HC) were evaluated with OCTA scans including 24 × 20mm scans centered on the fovea and 6 × 6mm centered on the optic disc. Automatically, OCTA scans were layered and partitioned by the device's built-in software, and the retinal and choroidal thickness and vessel density were automatically measured. SLE patients were further subdivided based on other organ involvement and disease activity. Differences in OCTA parameters between groups and their correlation with age, disease activity, duration of SLE and erythrocyte sedimentation rate (ESR) were investigated. RESULTS: This study included 42 SLE patients without retinopathy and 38 HC subjects. Compared with the HC group, SLE patients had significantly reduced retinal perifoveal vessel density (VD) in multiple sub-regions (Padj<0.05). In the lupus nephritis (LN) group, the retinal VD were significantly reduced (Padj<0.05), However, retinal thickness (RT) in multiple regions showed an increasing trend compared with the control group, yet the differences were not statistically significant. Moreover, the RT and VD were significantly decreased in neuropsychiatric SLE (NPSLE) group (Padj<0.05). Our research findings indicated a negative correlation between perifoveal superior retinal VD (β=-0.464, Padj=0.003) and SLE disease activity. Among the three groups of SLE disease activity, the mild activity group exhibited a compensatory increase in deep vascular density at the nasal perifoveal retina (Padj=0.047); the moderate activity group showed atrophy and thinning in multiple retinal regions (Padj<0.05); the severe activity group demonstrated a significant decrease in the choroidal vascularity index (CVI) in both the foveal (Padj=0.025) and temporal regions (Padj=0.012). Finally, among all ROC curve analysis results, the retinal thickness in the nasal peripheral region of the NPSLE group demonstrated the highest diagnostic value (AUC=0.9286). CONCLUSIONS: Wide-field OCTA is capable of comprehensively assessing both alterations of retinal and choroidal microvasculature and related fundus indicators, thereby facilitating the detection of preclinical retinal and choroidal modifications in patients with systemic lupus erythematosus (SLE).