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Risks of posterior segment ocular ischaemic events in patients with systemic lupus erythematosus: a population-based cohort study in Taiwan
  1. Yi-Ran Chiou1,2,
  2. Yu-Sheng Chang3,
  3. Chin-Fang Su2,3,4,
  4. Tzu-Hao Li5,
  5. Chien-Chih Lai2,4,
  6. De-Kuang Hwang1,2,6,
  7. Fang-Yi Wu3,
  8. Yu-Fan Chang1,2,6,7
  1. 1Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
  2. 2School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
  3. 3Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan
  4. 4Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  5. 5Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shin-Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
  6. 6School of Medicine, National Yang-Ming University, Taipei, Taiwan
  7. 7Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
  1. Correspondence to Dr Yu-Fan Chang, Ophthalmology, Taipei Veterans General Hospital, Taipei 112, Taiwan; lavoca{at}gmail.com

Abstract

Backgroud/Aim Ocular involvement in systemic lupus erythematosus (SLE) is often primarily recognised by ophthalmologists rather than internists. This study aims to investigate the incidence and risk factors for the occurrence of posterior ocular ischaemic events (OIE), including retinal vein occlusion (RVO), retinal artery occlusion (RAO) and ischaemic optic neuropathy (ION), in patients with SLE.

Methods A national database in Taiwan was used to identify 24 472 patients newly diagnosed with SLE and 244 720 age-matched and sex-matched controls between 1997 and 2012. New occurrences of OIE and confounding factors were recorded. The Kaplan-Meier method was used to compare the risk of OIE between the two groups. Fixed effect models were applied to evaluate the risk factors for OIE.

Results The mean age was 36.24±15.82 years and women accounted for 88.4%. Patients with SLE had significantly increased risk of overall OIE (HR 3.89, 95% CI 3.36 to 4.50, p<0.001) as well as each OIE subtype. End-stage renal disease (ESRD; HR 2.91, 95% CI 2.05 to 4.14, p<0.001), hypertension (HR 1.77, 95% CI 1.21 to 2.58, p=0.003) and congestive heart failure (HR 1.67, 95% CI 1.12 to 2.48, p=0.01) were associated with RVO development. Hypertension (HR 2.89, 95% CI 1.10 to 3.96, p=0.02) and ischaemic stroke (HR 3.58, 95% CI 1.97 to 6.48, p<0.001) had increased risk of RAO. ESRD was associated with ION (HR 3.03, 95% CI 1.41 to 6.51, p=0.004). Intravenous steroid was associated with RVO development (HR 2.54, 95% CI 1.67 to 3.84, p<0.001).

Conclusions SLE increases the risk of developing OIE. Systemic comorbidities and higher dosage of steroid in patients with SLE are associated with severe ocular ischaemic complications.

  • epidemiology
  • immunology
  • retina

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Y-RC and Y-SC contributed equally.

  • Contributors Substantial contribution to the conception or design of the work: Y-SC, D-KH, Y-FC. Acquisition, analysis or interpretation of data for the work: Y-RC, C-FS, T-HL, C-CL, F-YW. Drafting the work: Y-RC, Y-SC, Y-FC. Revising it critically for important intellectual content: C-FS, T-HL, C-CL, D-KH, F-YW, Y-FC. Final approval of the version to be published: all authors. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.