Retinal Microangiopathy in Systemic Lupus Erythematosus

To evaluate the prevalence of retinal microangiopathy in human immunodeficiency virus (HIV)-1–infected patients and its association with virologic, immunologic, and sociodemographic parameters.

Single-center cross-sectional study.

One hundred eighty-eight HIV-1-positive individuals from a single outpatient clinic.

Human immunodeficiency virus-positive patients were screened for signs of HIV-associated retinal angiopathy. Plasma HIV-1 RNA and CD4-positive cell counts were monitored within 3 months of the ophthalmologic assessment. The absence or presence of angiopathy or of opportunistic viral retinitis was then correlated to data respecting CD4-positive cell count, plasma viral load of HIV-1, and sociodemographic parameters.

Association between CD4-positive cell count, HIV-1 plasma viral load, sociodemographic parameters, and the manifestation of retinal microangiopathy.

At the baseline consultation, 130 (69%) patients exhibited no retinal pathologic features, 45 (24%) manifested retinal angiopathy, and 13 (7%) had opportunistic viral retinitis. In univariate analysis, retinal angiopathy was associated with lower CD4-positive cell count and higher HIV-1 plasma viral load. In a multivariate logistic model, the presence of retinal microangiopathy was associated with higher age (P = 0.02) and higher viral load of HIV-1 (P < 0.005), but not with lower CD4 cell counts (P > 0.05).

Human immunodeficiency virus-associated retinal microangiopathy is likely a multifactorial condition. Its presence is associated with higher age and higher replication of HIV-1 as measured by plasma HIV-1 RNA levels. In contrast to opportunistic infectious retinitis, the degree of immunodeficiency does not seem to be independently correlated with retinal angiopathy.

The starting point in the assessment of SLE-retinopathy is the clinical examination by ophthalmoscopy and retinal fluorescein angiography. It is noted that two major clinical forms of retinopathy may occur in SLE; (1st) the “classic” type characterized by cotton-wool spots with or without intraretinal hemorrhages, and (2nd) the thrombosis of larger retinal blood vessels, such as central or branch arteries/veins.

However, a well-defined pathogenetic classification of SLE-retinopathy has still not been proposed as yet. A practical classification based on the pathogenesis could be of aid to commence a more appropriate treatment. The aims of this paper are; (1st) to focus on the most implicate mechanisms of retinal vascular disease in SLE, (2nd) to mention the most common features associated with the different forms of retinopathy, and finally (3rd) to assess the prevalence of retinopathy in SLE.

In our opinion, it seems that two major types of retinopathy exist in SLE: firstly, the Hughes’ retinopathy due to antiphospholipid-induced retinal vascular thrombosis, for which anticoagulation is the best treatment, and secondly, the “classic” retinopathy in which at least two major causes could be associated; vasculitis and accelerated atherosclerosis.

In patients with “classic” retinopathy, the most appropriate treatment still needs to be established. If “classic” retinopathy is due to vasculitis, immunosuppressive drugs should be administered, while if atherosclerosis play an etiologic role, a prophylaxis with antioxidants or the use of low-dose aspirin should be assessed.

Purpose: To evaluate the ocular involvement in patients with the primary antiphospholipid syndrome.

Methods: The authors performed a cross-sectional ophthalmologic study of 17 patients with the primary antiphospholipid syndrome. Retinal fluorangiography was performed in 13 patients.

Results: Visual symptoms were described by ten patients. Visual acuity was markedly decreased in five eyes. Conjunctival telangiectases and microaneurysms, in addition to single instances of bilateral episcleritis and timbal keratitis, were the anterior segment findings. Fundus abnormalities were present in 15 patients. Venous tortuosity was the most common finding but there were instances of optic disc edema, vitreous hemorrhages, cotton-wool spots, vitreous bands, serous detachment of the macula, and retinal capillary abnormalities. Fluorangiography showed vaso-occlusive retinopathy in six eyes (5 patients, 29%). Choriocapillary vessel occlusion was observed in two eyes (1 patient) and binocular reticular degeneration of pigmentary epithelium was present in another case.

Conclusion: The eye is frequently involved in the primary antiphospholipid syndrome, and serious ocular damage may occur. Detailed ophthalmologic evaluation is warranted in these patients.

We quantified the retinal microvascular abnormalities in 57 eyes from autopsy patients with the acquired immunodeficiency syndrome (AIDS) and in 24 eyes from gender- and age-matched control subjects. We related retinal vascular changes to the topography of cytomegalovirus retinitis. Analysis of retinal trypsin digests revealed more vascular attenuation (P = .005), increased ratio of endothelial cells to pericytes (P = .001), and more microaneurysms (P = .02) in eyes of AIDS patients without cytomegalovirus retinitis than in those of control subjects. Cytomegalovirus retinitis was frequently bilateral, extensive, and distributed along blood vessels. Peripheral retinitis was more frequent than macular infection. Lymphocytes aggregated focally in arterioles, venules, and capillaries leading to areas infected with cytomegalovirus. Acquired immunodeficiency syndrome microvasculopathy occurs in the absence of cytomegalovirus retinitis and is not accounted for by immunosuppression alone. The location and character of these vascular changes in AIDS indicate an ischemic pathogenesis. In AIDS patients with cytomegalovirus retinitis, the vascular changes are more profound and include capillary destruction.

The severity of conjunctival microvascular changes and the presence of cotton-wool spots were compared to factors that may affect blood flow (hematocrit level, red cell aggregation, fibrinogen level, plasma viscosity, circulating immune complexes, and quantitative immunoglobulin levels) in 22 human immunodeficiency virus-infected individuals. The severity of conjunctival disease was associated with increased zeta sedimentation ratios (a measure of red cell aggregation) and fibrinogen levels. The presence of cotton-wool spots was also associated with higher fibrinogen levels. Plasma viscosity and quantitative IgG levels were above normal levels in most patients, although a relationship to disease severity was not established. Altered blood flow may contribute to vascular damage and ocular ischemic lesions in patients with human immunodeficiency virus infection.