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particularly in the right eye. Two months following laser photocoagulation and 6 weeks after commencement of warfarin, the disc new vessels had regressed. Six months into follow-up, his condition is stable. CommeJltAntiphospholipid antibodies were first detected as a result of disturbances they cause in routine biological tests. These effects include lupus anticoagulant in the augmented partial thromboplastin test (APTT) and false serological tests for syphilis in the VDRL test. The systemic clinical features are mild thrombocytopenia, chorea, heart valve disease, livedo reticularis and, most co mmonly, recurrent pregnancy loss. The mechanism by which they paradoxically cause thrombosis ill viuo has been debated. A direct antigen-antibody interaction in the vascular wall seems to be an attractive concept.IO Symptomatic central and branch retinal arteriolar oc clusions, ischaemic and non-ischaemic central retinal vein occlusions and ischaemic optic neuropathy have all been described in the primary and secondary APL sy ndromes.5-� Our patient was asymptomatic and even reluctant to undergo panretinal scatter photocoagulation.Castanon et Ill.]] studied 17 patients with the primary syndrome and found vascular changes in all, although only 10 patients described visual symptoms. This study and our case report highlight the importance of ocular screening in such individuals.Aggressive steroid therapy, aspirin and dipyridamole have not universally shown beneficial effects in controlling visual symptoms and preventing progression of vaso-occlusion.6,H,9,l2 Recently, in a randomised controlled clinical trial, low-dose aspirin (75 mg) together with heparin has been shown to be more effective than aspirin alone in improving outcome of pregnancy in recurrent fetal loss associated with this syndromeY The patient described by Manzanares et Ill? experienced a similar beneficial effect on switching from aspirin to acenocoumarol. Oral anticoagulants probably need to be continued for at least 6 months or, in the secondary syndrome, until the PTT becomes normal. Case reportA 65-year-old man presented with a 2 week history of a red, aching right eye associated with reduced vision. He had no problems with his left eye and no past ocular history. In his past medical history he had eczema and had become asthmatic 2 years previously; the asthma initially required oral steroids but more recently had been controlled with inhaled steroids and a beta-agonist. Two years previously he 'had required surgery for an inguinal hernia, He was a retired gastroenterologist and his latest travel abroad had been to Egypt 2 years previously. On examination his left eye saw 6/5 and was entirely normal. The right eye was injected and the visual acuity was count fingers with moderate anterior chamber activity and 2+ cells in the vitreous. The fundus (Fig. 1) showed a white, fluffy area at the macula associated with haemorrhage. The fluorescein angiogram (Fig. 2) showed masking by the haemorrhage with some leakage associated with the pale lesion. General ex...

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