Systemic Lupus Erythematosus Can Raise Ocular Ischemic Event Risk

The risk for posterior ocular ischemic events (OIEs) is elevated among patients with systemic lupus erythematosus (SLE), according to results of a study published in the British Journal of Ophthalmology.

This population-based retrospective cohort study was conducted using data from the National Health Insurance Research Database (NHIRD), which was established in 1995 and includes medical claims from residents in Taiwan. The primary outcome of this study was to evaluate risk for new incidence of OIE among patients with SLE using an age- and gender-matching approach to compare cases with controls.

There were 24,472 new cases of SLE between 1997 and 2012 and a group of 244,720 matched controls were identified. The SLE and control cohorts were aged mean 36.24±15.82 and 36.24±15.82 years and 11.60% and 11.60% were men, respectively.

The incidence of OIE was 1.09% among the SLE cohort compared with 0.37% among the controls (P <.001). Stratified by type of OIE, SLE was associated with a higher incidence of retinal vein occlusion (RVO; 0.71% vs 0.28%; P <.001), retinal artery occlusion (RAO; 0.22% vs 0.05%; P <.001), and ischemic optic neuropathy (ION; 0.16% vs 0.04%; P <.001).

Risk was elevated among the SLE group for severe OIE (relative risk [RR], 3.89; P <.001), severe RAO (RR, 6.29; P <.001), severe ION (RR, 5.20; P <.001), and severe RVO (RR, 3.48; P =.01).

Stratified by gender, risk was increased for all OIEs among men with SLE (RR, 4.10; P <.001) and women with SLE (RR, 3.88; P <.001). Stratified by age, risk for all OIEs was elevated for individuals with SLE aged ≤18 years (RR, 22.14; P <.001) and 19-50 years (RR, 6.96; P <.001). For individuals with SLE aged ≥51 years, only risk for RVO was elevated (RR, 1.68; P =.003).

Among patients with SLE, risk for RVO was associated with end-stage renal disease (hazard ratio [HR], 2.91; P <.001), intravenous steroids (HR, 2.54; P <.001), hypertension (HR, 1.77; P =.003), oral daily dose >7.5 mg (HR, 1.70; P =.002), congestive heart failure (HR, 1.67; P =.01), and age (HR, 1.02; P <.001) For RAO, risk was associated with ischemic stroke (HR, 3.58; P <.001), oral daily dose >7.5 mg (HR, 2.06; P =.02), and age (HR, 0.97; P <.008). ION was associated with intravenous steroids (HR, 11.64; P <.001) and end-stage renal disease (HR, 3.03; P =.004).

“Patients with SLE should be instructed to consult an ophthalmologist as soon as possible whenever acute vision loss occurs. Immediate recognition of retinal vaso-occlusion or ION and subsequent early and intensive therapy may provide visual recovery and retinal reperfusion,” according to the researchers.

This study was limited by not having access to clinical data about disease severity or ophthalmic examinations.

The results of this study indicated that patients with SLE, especially those aged 50 years or younger, were at increased risk for any form of severe OIE. Clinicians should instruct their patients to contact an ophthalmologist as soon as possible in the event of acute vision loss.