Systemic lupus erythematosus presenting earlier as retinal vaso-occlusion

Retinal vascular lesions are the most common ophthalmologic manifestation of systemic lupus erythematosus (SLE), occurring in 3% to 29% of cases, generally late in the disease. More rare is the severe vaso-occlusive disease, often termed "retinal vasculitis", which includes central retinal artery occlusion, multifocal arteriolar occlusions, extensive capillary nonperfusion and central venous occlusion. Patients with SLE and raised serum concentrations of anticardiolipin antibodies (ACA) have a higher risk of developing occlusive ocular vascular disease. We report a case in which retinal involvement was an earlier manifestation of SLE in a patient without ACA.

A Case of Severe Retinal Vaso-occlusive Disease in Systemic Lupus Erythematosus

Systemic lupus erythematosus(SLE) is a multisystem disorder in which the various organs are damaged by deposition of autoantibodies and immune complex. Ocular man-ifestations of SLE are involvement of the eyelids, conjunctiva, cornea, episclera, retina and optic nerve. Retinal vascular manifestations are the most common form of ocular manifestation. Most frequently these consist of cotton wool spots, retinal hemorrhage, but occasionally more severe retinal vaso'occlusive disease has been noted. The authors experienced 22 year'old woman who had SLE and severe retinal vaso'occlusive disease. Her left eye was treated with focal photocoagulation and vitrectomy but the visual acuity was F.C. 60 cm due to ischemic state of parafoveal capillary network. Right eye maintain visual acuity of 0.9 by photocoagulation and vitrectomy for vitreous hemorrhage and tractional retinal detachment. As shown in this case, the SLE patients who developed vitreous hemorrhage due to extensive retinal vaso-occlusive disease may have very poor visual prognosis. So periodic ocular examinations and appropriate treatment for vascular occlusion can prevent serious visual loss in SLE.