Retinopathy in systemic lupus erythematosus: Pathogenesis and approach to therapy

The starting point in the assessment of SLE-retinopathy is the clinical exa mination by ophthalmoscopy and retinal fluorescein angiography. It is noted that two major clinical forms of retinopathy may occur in SLE: (Ist) the " classic" type characterized by cotton-wool spots with or without intraretin al hemorrhages, and (2nd) the thrombosis of larger retinal blood vessels, s uch 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 pat hogenesis could be of aid to commence a more appropriate treatment. The aim s of this paper are; (Ist) to focus on the most implicate mechanisms of ret inal vascular disease in SLE, (2nd) to mention the most common features ass ociated with the different forms of retinopathy, and finally (3rd) to asses s 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 va scular thrombosis, for which anticoagulation is the best treatment, and sec ondly, the "classic" retinopathy in which at least two major causes could b e associated; vasculitis and accelerated atherosclerosis, In patients with "classic" retinopathy, the most appropriate treatment stil l needs to be established. If "classic" retinopathy is due to vasculitis, i mmunosuppressive drugs should be administered, while if atherosclerosis pla y an etiologic role, a prophylaxis with antioxidants or the use of lent-dos e aspirin should be assessed, (C) American Society for Histocompatibility a nd Immunogenetics, 1999 published by Elsevier Science Inc.