Transient myopia with severe chemosis as an initial manifestation of systemic lupus erythematosus.

Abstract A 24-year-old woman suffered from blurred vision and periorbital edema with remittent fever. She was diagnosed as having systemic lupus erythematosus (SLE), complicated with myopia and retinopathy and severe chemosis. Antiphospholipid syndrome (APS), hemophagocytic syndrome, and liver involvement were also proven. We considered that APS might cause chemosis as a result of thrombosis-induced perfusion failure in the conjunctiva. In such cases, APS should be considered and anticoagulation therapy associated with steroid therapy should be initiated. In systemic lupus erythematosus (SLE), chemosis, severe hepatitis, and hemophagocytic syndrome (HPS) are rare complications. It is well known that many cases of SLE are complicated with antiphospholipid syndrome (APS), which causes arteriovenous thrombosis. We report a case of SLE with transient myopia and severe chemosis complicated with severe hepatitis and HPS. As this patient had antiphospholipid antibodies, these ocular complications were considered to be related to APS.

[Choroidal venous dilatation in serous retinal detachment].

We studied the correlation between choroidal venous dilatation, intrachoroidal leakage of dye, and subretinal leakage from the choroid in patients with serous retinal detachment unaccompanied by choroidal neovascularization. We reviewed 13 eyes with anamnesis of serous retinal detachment, 23 eyes without anamnesis, and one eye of unknown status of a total of 37 eyes. Regarding the relationship between subretinal dye leakage from the choroid in fluorescein angiography (FAG) and choroidal venous dilatation in indocyanine green angiography (ICG), the point of subretinal leakage (31 points) was on and/or in the neighborhood of the site of choroidal venous dilatation in 87.1% of the 27 eyes, except for eyes of unknown site of leakage in FAG. The point of subretinal leakage was within and/or in the neighborhood of the intrachoroidal leakage of dye in ICG in 92% of the eyes. In serous retinal detachment without choroidal neovascular membranes, serous retinal detachment may be caused by breakdown of the outer retinal barrier due to choroidal venous congestion and intrachoroidal diffusion.

[Study of choroidal vascular lesions in central serous chorioretinopathy using indocyanine green angiography].

We performed fluorescein and indocyanine green (ICG) angiographies in 56 patients with central serous chorioretinopathy, and studied the choroidal lesions. In the early phase, choroidal filling with ICG was delayed in 77% in the area including focal leakage. Hypofluorescent findings around the site of focal leakage persisted through the phase in 23%, and we think this finding was caused by filling defect of the choriocapillaris. In the late phase, choroidal tissue staining by ICG was present in 82% in the area including focal leakage. Multiple areas of choroidal staining were also present in unaffected areas in 43% and in 62% of fellow eyes. Choroidal tissue staining by ICG was revealed in 48% in the area of choroidal filling delay, and this finding persisted after focal leakage had disappeared following photocoagulation. We think this finding was caused by choroidal vascular hyperpermeability. These findings suggest that choroidal circulatory disturbance and choroidal vascular hyperpermeability play a causative role in damage to the retinal pigment epithelium in central serous chorioretinopathy.