Peripapillary retinal nerve fiber layer and choroidal vascularity correlate with disease activity in systemic lupus erythematosus.

PURPOSE: Systemic lupus erythematosus (SLE) confers risk of subclinical neurovascular injury. We assessed retinal and choroidal structural alterations using spectral-domain optical coherence tomography (SD-OCT) and evaluated their relationship with disease activity and immunological markers.

METHODS

In this prospective, cross-sectional study, 70 SLE patients and 35 age- and sex-matched healthy controls underwent comprehensive ophthalmic examination. SD-OCT with enhanced depth imaging was used to assess peripapillary retinal nerve fibre layer (pRNFL) thickness, macular thickness, and choroidal vascularity index (CVI). Disease activity was measured using the SLE Disease Activity Index-2 K (SLEDAI-2 K). Patients were stratified into active (SLEDAI ≥ 6, n = 18) and inactive (SLEDAI ≤ 5, n = 52) subgroups.

RESULTS

Compared to controls, SLE patients had significantly thinner global pRNFL (94.5 ± 5.0 μm vs. 100.5 ± 5.0 μm, p < 0.001) and lower CVI (65.6 ± 2.0% vs. 68.9 ± 2.0%, p < 0.001). Thinning was most pronounced in the temporal superior (TS) and temporal inferior (TI) sectors. Active SLE patients showed greater pRNFL thinning and lower CVI than inactive patients (p < 0.01). SLEDAI scores correlated negatively with temporal pRNFL thickness (TS: r=-0.58; TI: r=-0.56) and CVI (r=-0.63) (all p < 0.001). Anti-dsDNA positivity correlated with reduced pRNFL and CVI, while complement C3 levels showed positive correlations.

CONCLUSION

SD-OCT reveals significant temporal pRNFL thinning and reduced CVI in SLE patients, correlating with systemic disease activity and immunologic markers. These findings support the retina and choroid as accessible sites reflecting SLE-related neurovascular inflammation and contribute to understanding of ocular involvement in disease pathophysiology; longitudinal studies are needed to determine their utility for disease monitoring.