1/3. review of severe vaso-occlusive retinopathy in systemic lupus erythematosus and the antiphospholipid syndrome: associations, visual outcomes, complications and treatment.PURPOSE: To discuss the pathogenesis of severe vaso-occlusive retinopathy in systemic lupus erythematosus (SLE), the association with antiphospholipid antibodies, and its implications for management and prognosis. methods: An illustrative case history of a woman with SLE and severe vaso-occlusive retinopathy in the presence of antiphospholipid antibodies is presented. A literature review of previously reported cases and previously published data on the topic was performed and forms the basis for discussion. RESULTS: This is a rare form of retinopathy in SLE as distinct from the more common, benign form, being classically a microangiopathy with diffuse capillary non-perfusion and small arterial or arteriolar occlusions in the retina. Poor visual outcomes with visual loss are reported in 80% of cases with neovascularization occurring in 40% of cases. It is associated with antiphospholipid antibodies, typically characterized by microthrombosis and immune complex mediated vasculopathy rather than a true vasculitis. There is a strong association between this severe form of retinopathy and central nervous system manifestations of SLE. Anticoagulation has a role in the secondary prevention of thrombosis in the presence of antiphospholipid antibodies, but the role of aspirin and immunosuppression is unclear in the treatment of this condition. Vigilant ophthalmic follow up and aggressive treatment of neovascularization and vitreous haemorrhage can prevent further visual loss. These points are highlighted in the brief case report presented. CONCLUSION: Severe vaso-occlusive retinopathy is a rare form of retinopathy in SLE often associated with poor visual prognosis and neovascularization. It may be a manifestation of the antiphospholipid syndrome. Treatment is aimed at preventing further thrombosis and complications arising from neovascularization.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/3. Combined central retinal artery and vein occlusion in churg-strauss syndrome: case report.PURPOSE: To describe a rare case of churg-strauss syndrome presenting with severe visual loss due to a combined central retinal vein and artery occlusion. methods: A 42-year old man with a medical history of asthma and blood hypereosinophilia developed a sudden loss of vision in his right eye. We describe the clinical features and evolution of the case after treatment. RESULTS: A combined occlusion of the central retinal artery and central retinal vein was diagnosed by the funduscopic appearance of retinal whitening, macular cherry-red spot, papilloedema, retinal haemorrhages in all four quadrants and dilated and tortuous veins. The diagnosis was confirmed by a fluorescein angiogram showing absence of retinal filling and normal choroidal filling. churg-strauss syndrome was diagnosed based on the necessary presence of four of six criteria for the disease proposed by the American College of rheumatology. Corticosteroid therapy was initiated. However, during the following year when tapering off the daily dosage, the patient experienced two relapses, with pulmonary symptoms and hypereosinophilia, and the corticosteroid dosage had to be augmented. The patient presented with neovascular glaucoma 7 weeks after the vascular occlusion and experienced no visual improvement. CONCLUSION: Combined central retinal artery and vein occlusion can occur in churg-strauss syndrome. We suggest that regional vasculitis may be the pathological mechanism underlying the vascular occlusions observed in our case. The condition carries a very poor prognosis for vision, due to the resulting retinal ischaemia, and a poor general prognosis due to the late stage of the systemic disease. Corticosteroids should be instigated promptly in order to prevent further systemic or ocular vasculitis.- - - - - - - - - - ranking = 106.11828128358keywords = retinal haemorrhage, haemorrhage (Clic here for more details about this article) |
3/3. Central retinal vein occlusion combined with occlusion of a cilioretinal artery. A case report.An otherwise healthy 39-year-old man with a dark spot in the visual field of his left eye showed retinal whitening, indicating a cilioretinal arterial obstruction and minor signs of venous stasis at the initial examination. The affected cilioretinal artery filled normally during fluorescein angiography. The visual acuity was 1.0 bilaterally. One week later, the retinal whitening had decreased and signs of central retinal venous occlusion (venous dilatation, retinal haemorrhages and papillary oedema) predominated in the fundus picture. The patient was treated with oral betamethasone and acetylsalicylic acid. The patient was free of symptoms and the fundus normalized within 10 months. The pathogenesis of cilioretinal arterial obstruction combined with central retinal venous occlusion is not established. The clinical course in this case seems to favour a hypothesis of a primary arterial affection.- - - - - - - - - - ranking = 106.11828128358keywords = retinal haemorrhage, haemorrhage (Clic here for more details about this article) |