Ocular microvascular alteration in Sjögren's syndrome treated with hydroxychloroquine: an OCTA clinical study

Chao Yu; Jie Zou; Qian-Min Ge; Xu-Lin Liao; Yi-Cong Pan; Jie-Li Wu; Ting Su; Li-Juan Zhang; Rong-Bin Liang; Yi Shao

doi:10.1177/20406223231164498

Ocular microvascular alteration in Sjögren's syndrome treated with hydroxychloroquine: an OCTA clinical study

Ther Adv Chronic Dis. 2023 Apr 17:14:20406223231164498. doi: 10.1177/20406223231164498. eCollection 2023.

Authors

Chao Yu^{1

2}, Jie Zou¹, Qian-Min Ge¹, Xu-Lin Liao³, Yi-Cong Pan¹, Jie-Li Wu⁴, Ting Su^{5

6}, Li-Juan Zhang¹, Rong-Bin Liang¹, Yi Shao⁷

Affiliations

¹ Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, P.R. China.
² The First Clinical Medical College, Nanchang University, Nanchang, P.R. China.
³ Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong.
⁴ Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, Xiamen University School of Medicine, Xiamen, P.R. China.
⁵ Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, Xiamen University School of Medicine, Xiamen, Fujian, P.R. China.
⁶ Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
⁷ Department of Ophthalmology and Jiangxi Province Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Donghu, Nanchang 330006, P.R. China.

Abstract

Background: Sjögren's syndrome (SjS) is a rare autoimmune disease, and despite our knowledge of SjS, we still lack effective treatments. Chloroquine drugs used to treat autoimmune diseases are still the primary medicine for SjS but increase the risk of chloroquine retinopathy.

Objectives: The objective of this study is to use Optical Coherence Tomography Angiography (OCTA) images to monitor the microvascular changes in the fundus of SjS patients after hydroxychloroquine (HCQ) treatment and the feasibility of using them as diagnostic indicators.

Design: This is a retrospective observational cohort study.

Methods: Twelve healthy controls (HCs group; 24 eyes), 12 SjS patients (SjS group; 24 eyes), and 12 SjS patients treated with HCQ (HCQ group; 24 eyes) were recruited. Three-dimensional OCTA images of the retina were collected, and microvascular density was calculated for each eye. OCTA image segmentation for analysis was conducted using the central wheel division method (C1-C6), hemisphere segmentation method (SR, SL, IL, and IR), and the early treatment of diabetic retinopathy study method (ETDRS) (R, S, L, and I).

Results: Retinal microvascular density was significantly lower in the SjS patients compared to the HCs group (p < 0.05) and much lower in the HCQ group compared to the SjS patients (p < 0.05). The SjS and HCQ groups differed in the I, R, SR, IL, and IR regions in the superficial and deep retina and the S region in the superficial retina. The ROC curves of the relationship between the HCs and SjS groups and between the SjS and HCQ groups demonstrated good classification accuracy.

Conclusion: HCQ may contribute significantly to the microvascular alteration in SjS. Microvascular alteration is a potential marker with adjunctive diagnostic value. The MIR and the OCTA images of I, IR, and C1 regions showed high accuracy in minoring the alteration.

Keywords: Sjögren’s syndrome; hydroxychloroquine (HCQ); optical coherence tomography angiography (OCTA); retinal changes; vessel density.