Acute vision loss in systemic lupus erythematosus: bilateral combined retinal artery and vein occlusion as a catastrophic form of clinical flare

Akhlaghi, Mohammadreza; Abtahi‐Naeini, Bahareh; Pourazizi, Mohsen

doi:10.1177/0961203317727602

Cited by 21 publications

(10 citation statements)

References 18 publications

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“…The second patient with BRAO with evolving CRVO from the non-ischaemic type into the ischaemic variant, despite being on an aggressive treatment protocol, makes an interesting case study. Only eight cases of different combinations of the branch or BRAO/CRAO and CRVO, as an ophthalmic emergency, have been reported in SLE [5][6][7]14]. The exact pathogenesis of simultaneous BRAO/CRAO with CRVO in SLE remains unknown, but the hypercoagulable state is considered to be an essential factor.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, the common manifestations of retinopathy are cotton wool spots, retinal hemorrhages, and optic disc edema caused by chronic occlusive changes in small retinal arterioles [4]. Severe vaso-occlusive retinopathy in the combination form of branch retinal artery occlusion (BRAO)/central retinal artery occlusion (CRAO) with central retinal vein occlusion (CRVO) is rare, with only a few reported cases in the literature [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Severe Vaso-Occlusive Retinopathy in Systemic Lupus Erythematosus: A Case Series

Kumar¹,

Dan²,

Sinha³

et al. 2021

Cureus

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This study aims to describe the clinical profile of severe vaso-occlusive retinal disorders in patients with systemic lupus erythematosus (SLE) and it is a retrospective case series. The clinical characteristics of three patients with SLE with vascular occlusions in four eyes were described. Branch retinal artery occlusion (BRAO) was present in all three patients with combined non-ischemic central retinal vein occlusion (NICRVO) in one patient and evolving ischemic CRVO in another patient. Additional branch retinal artery insufficiency was observed in the other eye of a patient with BRAO. Antinuclear antibody (ANA) titer was elevated in all patients. One patient had a positive lupus anticoagulant with elevated activated partial thromboplastin time (aPTT), and concurrent homocysteinemia was present in another patient. Intravitreal anti-vascular endothelial growth factor (ranibizumab) injection was administered to two eyes. Intravenous methyl prednisolone (IVMP) injection along with oral azathioprine was used in all patients with the need for anticoagulation in two patients along with SLE treatment. Vision in two eyes did not improve to the functional level despite aggressive therapy. Visually blinding severe vaso-occlusive retinopathy in the form of BRAO with or without CRVO can manifest in patients with SLE. Undetected antiphospholipid syndrome and homocysteinemia may be associated risk factors for such ophthalmic complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Severe Vaso-Occlusive Retinopathy in Systemic Lupus Erythematosus: A Case Series

Kumar¹,

Dan²,

Sinha³

et al. 2021

Cureus

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“…The degree or pattern of visual impairment is comparable to that of CRAO. Many reports have shown that CCRAVO frequently decreases visual acuity to FC and HM, or even to NLP [6, 12, 16, 17], but a few researchers have also shown that fairly good visual acuity can be maintained [10, 18–20]. In Brown's study [12], 87% (20/23) of eyes with CCRAVO had visual acuity between FC and NLP.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features of Combined Central Retinal Artery and Vein Occlusion

Wang

Chang

Zhang

et al. 2019

Journal of Ophthalmology

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Purpose To describe the clinical features of combined central retinal artery and vein occlusion (CCRAVO). Methods This retrospective study included 33 admitted patients (33 eyes) who had CCRAVO. Clinical data, such as age, gender, best-corrected visual acuity (BCVA), intraocular pressure (IOP), findings on fundus color photography and fundus fluorescein angiography (FFA), and information about follow-up, were collected and analyzed. Results The age of the patients with CCRAVO ranged from 22 to 78 years, with a mean of 48.8 ± 14.1 years. At presentation, BCVA of the involved eyes ranged from no light perception (NLP) to 20/20. In addition, 45.5% (15/33) of the eyes had BCVA of finger counting (FC) or below, whereas 12.1% (4/33) had BCVA of 20/60 or above. The IOP was lower in the involved eyes than in the fellow eyes (15.0 ± 3.0 mmHg vs. 16.4 ± 2.3 mmHg, p=0.03). Ophthalmoscopic examination showed changes in both central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO), including retinal hemorrhage, retinal ischemic whitening, optic disc hyperemia and/or edema, venous dilation and tortuosity, cotton wool spot (CWS), and Roth's spot. FFA showed prolonged arm-to-retina time (ART) and retinal arteriovenous passage time (RAP) (17.1 ± 4.9 s and 12.1 ± 8.8 s, respectively). Capillary nonperfusion (CNP) was seen in 21 eyes (63.6%), and in 14 (42.2%) of these, CNP was larger than 10 disc areas. At 2 to 3 weeks after presentation, BCVA improved in 23 eyes (71.9%) and further deteriorated in 5 eyes (15.6%). Retinal ischemic whitening improved in more than half of the eyes, whereas retinal hemorrhage increased in nearly half of the eyes. Follow-up ranged from 6 to 56 months. Seven patients were lost to follow-up. At final follow-up, six eyes had a visual acuity of 20/60 or greater, but 6 eyes had FC or worse. Four eyes developed neovascularization on follow-up. Conclusion CCRAVO is a sight-threatening entity. Manifestations of CRAO and CRVO can be seen simultaneously in the early stage of disease, and CRVO may play a more important role in the development of CCRAVO.

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“…Adicionalmente, su unión a los receptores tipo Toll-4 precipita el desencadenamiento de esta vía de señalización y la activación de células endoteliales, que culmina con un estado protrombótico generado por la expresión de moléculas de adhesión intracelular 1, moléculas de adhesión vascular celular 1, selectina E, aumento del factor tisular e incremento de citocinas proinflamatorias como la interleucina 1 y el factor de necrosis tumoral. Por otro lado, las plaquetas son también activadas por este complejo antígeno-anticuerpo a través del receptor de lipoproteína de baja densidad relacionado con la proteína 8 y el receptor adhesivo plaquetario de la glucoproteína Ibα, llevando a un aumento en la producción de tromboxano A2 [8][9][10] .…”

Section: Discussionunclassified

Oclusi�n vascular mixta de la retina en una paciente con s�ndrome antifosfol�pido. Reporte de caso

Quijano-Nieto¹,

Martnez-Pulgarn²,

Reyes-Vivas³

2021

RSCO

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Acute vision loss in systemic lupus erythematosus: bilateral combined retinal artery and vein occlusion as a catastrophic form of clinical flare

Cited by 21 publications

References 18 publications

Severe Vaso-Occlusive Retinopathy in Systemic Lupus Erythematosus: A Case Series

Severe Vaso-Occlusive Retinopathy in Systemic Lupus Erythematosus: A Case Series

Clinical Features of Combined Central Retinal Artery and Vein Occlusion

Oclusi�n vascular mixta de la retina en una paciente con s�ndrome antifosfol�pido. Reporte de caso

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