Han Young Soo, min Yang Chan, Lee Sang-Hoon, Shin Jae Ho, Moon Sang Woong, Kang Ja Heon
Department of Ophthalmology, Graduate School, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Korea.
Department of Rheumatology, Kyung Hee University Hospital at Gangdong, Kyung Hee University, 892, Dongnam-ro, Gangdong-gu, Seoul, 05278, Korea.
BMC Ophthalmol. 2015 Oct 29;15:148. doi: 10.1186/s12886-015-0144-6.
We present a rare case of secondary angle closure glaucoma due to systemic lupus erythematosus choroidopathy as initial presentation of systemic lupus erythematosus, accompanied by central nervous system vasculitis and uncontrolled nephropathy.
A 31-year-old woman presented with decreased visual acuity, nausea, vomiting, fever, and bilateral angioedema-like eyelid swelling. She had persistent dry cough while taking medication for 3 months, and had usual posterior neck pain, which was treated with analgesic medication and Asian medicines. Intraocular pressure was 32 and 34 mmHg in her right and left eyes, respectively. Peripheral anterior chambers were shallow (grade I) using the van Herick method. Gonioscopy revealed 360° closed angle in both eyes. In both eyes, serous retinal detachment was found using optical coherence tomography and B scan ultrasonography, as well as choroidal thickening with effusion. Secondary acute angle closure glaucoma was drug induced, or caused by uveitis of unknown etiology when she was first treated with intraocular pressure-lowering medication. During evaluation of the drug-induced angioedema in the internal medicine department, systemic lupus erythematosus was diagnosed, based on malar rash, photosensitivity, proteinuria, and positive anti-Smith and anti-DNA antibodies, followed by initiation of steroid pulse therapy. Using fluorescein angiography, multifocal subretinal pinpoint foci were detected at the middle phase. We then diagnosed bilateral angle closure glaucoma by choroidal effusions, with lupus choroidopathy. At 2 months after steroid pulse therapy, subretinal fluid was not found, and visual acuity improved to normal. During the subsequent 2 years, lupus choroidopathy was not aggravated but lupus nephritis was not controlled.
Patients with systemic lupus erythematosus choroidopathy can develop ciliochoroidal effusion, which can lead to acute angle closure glaucoma. Systemic lupus erythematosus choroidopathy is an early sign of severe complications. Angle closure glaucoma by systemic lupus erythematosus choroidopathy can be effectively treated using antiglaucoma drugs and immunosuppressive therapy.
我们报告一例罕见的继发性闭角型青光眼，其病因是系统性红斑狼疮脉络膜病变，为系统性红斑狼疮的初始表现，并伴有中枢神经系统血管炎和未控制的肾病。
一名31岁女性，出现视力下降、恶心、呕吐、发热以及双侧血管性水肿样眼睑肿胀。她在服药3个月期间持续干咳，并有颈部后侧疼痛，曾接受止痛药物和中药治疗。她右眼和左眼的眼压分别为32 mmHg和34 mmHg。使用范赫里克方法检查发现周边前房浅（I级）。房角镜检查显示双眼360°房角关闭。双眼经光学相干断层扫描和B超检查发现浆液性视网膜脱离，以及脉络膜增厚并伴有渗出。首次使用降眼压药物治疗时，继发性急性闭角型青光眼是药物诱导的，或由病因不明的葡萄膜炎引起。在内科评估药物性血管性水肿期间，根据颧部皮疹、光敏性、蛋白尿以及抗史密斯抗体和抗DNA抗体阳性，诊断为系统性红斑狼疮，随后开始使用类固醇脉冲疗法。荧光素血管造影显示，在中期检测到多灶性视网膜下微小病灶。然后我们诊断为双侧脉络膜渗出性闭角型青光眼，并伴有狼疮脉络膜病变。类固醇脉冲疗法2个月后，视网膜下液消失，视力恢复正常。在随后的2年中，狼疮脉络膜病变未加重，但狼疮性肾炎未得到控制。
系统性红斑狼疮脉络膜病变患者可出现睫状脉络膜渗出，进而导致急性闭角型青光眼。系统性红斑狼疮脉络膜病变是严重并发症的早期迹象。系统性红斑狼疮脉络膜病变所致的闭角型青光眼可通过抗青光眼药物和免疫抑制疗法有效治疗。
