ABSTRACT
RATIONALE: Ocular involvements in systemic lupus erythematosus (SLE) are not rare but extremely varied. Here we present a very meaningful case with unilateral branch retinal artery occlusion (BRAO) secondary to undetected SLE, for which immunotherapy showed significant effect, which led to complete resolution of macular edema. PATIENT CONCERNS: A 31-year-old female patient, so far without any previous illnesses, presented with a sudden onset of painless diminution of vision in left eye for 5 days. Diagnosis: Signs of branch retinal artery occlusion and macular ischemic edema were observed on the left fundus, which was further confirmed by Fundus fluorescein angiography and OCT. BRAO was initially proposed. However, after ophthalmological treatment for BRAO, visual acuity and macular edema improvement was limited. Physical examination revealed erythema on the hands and feet, together with her experience of hair loss and joint pain. The patient was diagnosed with SLE. INTERVENTIONS AND OUTCOMES: The patient received systemic immunotherapy, which resulted in visual improvement to 20/20. LESSONS: This is a rare monocular vaso-occlusive retinopathy in SLE with mainly diffuse nonperfusion and small arterial and arteriolar occlusion in the retina, as distinct from more common vasculitis. Even without intravitreal injection of anti-VEGF, systemic immunotherapy can be effective for the treatment of macular edema.
Subject(s)
Lupus Erythematosus, Systemic , Macular Edema , Retinal Artery Occlusion , Retinal Diseases , Adult , Female , Fluorescein Angiography , Humans , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Macular Edema/diagnosis , Macular Edema/etiology , Macular Edema/therapy , Retinal Artery Occlusion/complications , Retinal Artery Occlusion/etiology , Retinal Diseases/complicationsABSTRACT
PURPOSE: 1. To evaluate the repeatability of macular pigment optical density (MPOD) measurements in non-mydriatic and mydriatic conditions with a single wavelength reflection photometry. 2. To compare the non-mydriatic measurement with the mydriatic measurement of MPOD values. METHODS: Fifty-one healthy young subjects were recruited in this prospective study. MPOD parameters including maximum optical intensity (OD), mean OD, volume and area, were measured using a single 460-nm wavelength reflection method (Visucam 200, Carl Zeiss Meditec) twice both before and after pupil dilation. Paired t test, Pearson's correlation, intraclass correlation coefficient (ICC) and Bland-Altman plots were used to evaluate the agreement and correlation of MPOD parameters before and after mydriasis. RESULTS: The differences of maximum OD, mean OD and volume between the two measurements without mydriasis was statistically significant for all parameters, but not significant between the two measurements with mydriasis or between non-mydriatic and mydriatic measures. The ICCs were higher for the two measurements with mydriasis (range: 0.687-0.840) than those without mydriasis (range: 0.448-0.695) or non-mydriatic and mydriatic measures (range: 0.473-0.769). The 95% limit of agreement (LOA) of measurements between the two measurements after mydriasis was the smallest among all the other comparisons. The coefficient of repeatability was lower for the measurements with mydriasis than those without mydriasis. CONCLUSIONS: MPOD measurement by Visucam 200 with mydriasis has higher repeatability than the measurement without mydriasis. The non-mydriatic and mydriatic measures had less agreement compared to the two measure after mydriasis. Therefore, mydriasis is recommended.
