Impact of systemic steroids combined with immunosuppressive treatment on glaucomatous features in patients with systemic lupus erythematosus

Marta P Wiącek; Danuta Bobrowska-Snarska; Marek Brzosko; Wojciech Lubiński; Monika Modrzejewska

doi:10.18240/ijo.2022.01.11

Impact of systemic steroids combined with immunosuppressive treatment on glaucomatous features in patients with systemic lupus erythematosus

Int J Ophthalmol. 2022 Jan 18;15(1):71-76. doi: 10.18240/ijo.2022.01.11. eCollection 2022.

Authors

Marta P Wiącek^{1

2}, Danuta Bobrowska-Snarska³, Marek Brzosko³, Wojciech Lubiński⁴, Monika Modrzejewska⁴

Affiliations

¹ First Department of Ophthalmology, Pomeranian Medical University, Szczecin 70-111, Poland.
² Institute of Physics, University of Szczecin, Szczecin 70-451, Poland.
³ Department of Rheumatology, Internal Medicine and Geriatrics, Pomeranian Medical University, Szczecin 71-252, Poland.
⁴ Second Department of Ophthalmology, Pomeranian Medical University, Szczecin 70-111, Poland.

Abstract

Aim: To evaluate the incidence of increased intraocular pressure (IOP) and glaucomatous changes in systemic lupus erythematosus (SLE) patients in comparison with systemic steroids and immunosuppressive treatment.

Methods: Sixty-two women with SLE were divided into two groups: treated (n=47, 94 eyes) and not treated (n=15, 30 eyes) with systemic glucocorticosteroids (GC; GC-free). Twenty-one individuals in GC group were treated with immunosuppressive agents (immunomodulating and biologic). The visual acuity and IOP with ocular pulsatile amplitude (OPA) measurements, as well as scanning laser polarimetry (GDx) with nerve fiber index (NFI) measurement, spectral domain optical coherence tomography (SD-OCT) of the optic disk with retinal nerve fiber layer (RNFL) analysis and the macular region with ganglion cell analysis (GCA) were performed.

Results: Mean IOP values in group with combined GC and immunosuppressive therapy was 15.8±2.56 mm Hg and was significantly lower than in individuals with exclusive GC treatment (17.63±4.38 mm Hg, P=0.043). Contrary, no differences in mean IOP values between GC-free group and individuals treated with combined GC and immunosuppressive therapy were detected (P=0.563). Similarly, mean IOP in GC was 17.14±3.94 mm Hg and in GC-free patients was equal to 16.67±3.45 mm Hg (P=0.671). According to treatment regimen no statistical differences in optic disk SD-OCT for RNFL thickness, RNFL symmetry, cupping volume and the C/D ratio were observed. Similarly, no statistical differences for the mean and minimal ganglion cell layer (GCL) thickness measured in macular SD-OCT or NFI in GDx were detected.

Conclusion: Combined immunosuppressive and systemic GC therapy in SLE patients may lower the risk of iatrogenic ocular hypertension. No relationship between treatment regimen and glaucomatous damage of optic nerve fibers in analyzed groups with SLE is detected.

Keywords: immunosuppression; ocular hypertension; steroid induced glaucoma; steroid therapy; systemic lupus erythematosus.

International Journal of Ophthalmology Press.