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Photo Essay |

Occlusive Retinal Vasculitis Associated With Systemic Lupus Erythematosus

Russell W. Read, MD; Lawrence P. Chong, MD; Narsing A. Rao, MD
Arch Ophthalmol. 2000;118(4):588-589. doi:10.1001/archopht.118.4.588.
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SYSTEMIC LUPUS erythematosus is an autoimmune disease associated with polyclonal B-cell activation and production of autoantibodies. Systemic lupus erythematosus can affect multiple organ systems, including the eye.1

A 31-year-old woman noted blurred vision in both eyes during hospitalization for an exacerbation of systemic lupus erythematosus. Her medications included 60 mg of prednisone per day. Seventeen years prior to our seeing her she had taken an unknown dose of hydroxychloroquine sulfate for 1 year. Results of prior retinal examinations were not available, but the patient reported previously normal vision in both eyes.

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Figure 1.

Right (left) and left (right) fundi at presentation show arteriolar sheathing, nerve fiber layer infarctions, and intraretinal hemorrhages. Macular pigment changes in a bull's-eye pattern are present in both eyes.

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Figure 2.

Right (left) and left (right) fundi 2 weeks after institution of cyclophosphamide treatment show early resolution of nerve fiber layer infarctions and intraretinal hemorrhages.

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Figure 3.

Right fundus (left) shows arteriolar sheathing but absence of nerve fiber infarctions and hemorrhage. Left fundus (right) shows arteriolar sheathing with recurrence of nerve fiber layer infarctions and intraretinal hemorrhages. Venous beading is present as well.

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Figure 4.

Fluorescein angiogram of the left eye shows occlusion of the arteries (arrows) and capillary nonperfusion of temporal macula (almost splitting the fovea) and peripheral retina. Photocoagulation scars can be seen inferiorly. Hyperfluorescence centrally is owing to window defects corresponding to pigment changes in the macula.

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Figure 5.

Right fundus (top) shows optic atrophy and sheathed, attenuated arterioles. Left fundus (bottom) shows chronically sheathed vessels and involuted fibrovascular tissue overlying the atrophic optic disc. Photocoagulation scars can be seen inferiorly. Macular bull's-eye pigmentary changes are seen in both eyes.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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