Retinal complications of gout: a case report and review of the literature

Abstract

BackgroundThere have been few reported findings of posterior segment complications of gout. While exudative lesions, an increased risk of macular degeneration, and vascular occlusions have been previously reported, to our knowledge, refractile macular lesions have not been reported in a patient with chronic uncontrolled gout.Case PresentationHighly refractile, crystal-like lesions were found in the macula of a 62 year old male patient with chronically uncontrolled gout. The lesions appeared at the termination of retinal arterioles and were located at the level of the retinal pigment epithelium. The lesions did not stain with fluorescein and were associated with larger areas geographic atrophy. Review of the patient’s blood tests revealed well-controlled vasculopathic risk factors. Fundus appearance and best-corrected visual acuity remained stable over 12 months of follow-up during which the uric acid levels were well controlled.ConclusionRetinopathy may be associated with chronically uncontrolled gout and patients with visual complaints should undergo a dilated examination in addition to the typical anterior segment slit-lamp exam.

Systemic Urate Deposition: An Unrecognized Complication of Gout?

“…Thirty-six articles were found in the literature documenting ocular urate deposition as seen by histopathology and clinical exam ( Table 1 ). Urate deposits have been reported in nearly all ocular and adnexal structures including the eyelid [ 55 ], medial and lateral canthus [ 56 , 57 ], conjunctiva [ 58 ], sclera [ 59 ], cornea [ 60 ], lens, iris [ 61 ], orbital fossa [ 62 ], and retina [ 63 ]. The eyes may be predisposed to tophi secondary to lower body temperatures and a low pH environment resulting in poor solvent capabilities [ 61 , 64 ].…”

“…A single case report documented a nonspecific orbital mass within the intra-orbital fossa which was biopsy proven to be tophus. Another case report described subretinal crystal deposits with adjacent regions of macular atrophy on fundoscopic exam and fluorescein angiogram in a patient with tophaceous gout presumed to be urate crystals [ 63 ] ( Figure 4 C,D). Recurrent uveitis has been seen in gout patients and may resolve with colchicine and corticosteroids [ 64 ].…”

“…2006;54(3):1025, Copyright ©2006 by the American College of Rheumatology [ 60 ]. ( C ) Fundoscopic exam images reveal numerous small refractile yellow lesions in the macula suggestive of crystal deposition as well as areas of geographic atrophy [ 63 ]. ( D ) Fluorescein angiogram images demonstrate window defects and regions of peripapillary atrophy.…”

“…BMC Ophthalmol. 2018;18(1):11, distributed in accordance with a Creative Commons Attribution 4.0 International License ( [ 63 ]. ( E ) Photograph showing tortuous blood vessels along the scleral and conjunctival surfaces.…”

Profile of netarsudil ophthalmic solution and its potential in the treatment of open-angle glaucoma: evidence to date

“…Furthermore, netarsudil’s novel mechanism of action may allow for IOP-lowering efficacy in patients with suboptimal response to other available agents. 30 …”