Prakash Sarvesswaran, Gunderia Akruti Mayur, Khadar Syed Mohideen Abdul
Post Graduate Institute of Ophthalmology, Aravind Eye Hospital, Tamil Nadu, India.
Post Graduate Institute of Ophthalmology, Vitreo-Retinal Clinic, Aravind Eye Hospital, Tamil Nadu, India.
Lupus. 2023 May;32(6):804-809. doi: 10.1177/09612033231171342. Epub 2023 Apr 14.
A known case of Systemic Lupus Erythematosus (SLE) developed sudden loss of vision (no light perception) with relative afferent pupillary defect in her right eye (RE) and fundus examination revealed cherry red spot over tomato splash background with tortuous and dilated veins suggestive of combined central retinal arterial and vein occlusion.
Left eye (LE) had 6/6 vision but posterior segment revealed a hyperemic disc. Fundus fluorescein angiography (FFA) revealed delayed arm to retina time and increased arterial to vein transit time in RE. LE showed pooling of dye around optic disc suggestive of SLE related Optic neuritis. Patient was re-evaluated and she tested positive for Lupus anticoagulant. Patient was diagnosed to have anti-phospholipid antibody syndrome (APS) occurring secondary to SLE. She was started on intra venous steroids, anti-coagulants and disease progression in left eye was controlled.
We report a rare simultaneous presentation of complete combined occlusion of central retinal artery and vein (CCRAVO) in RE and Optic neuritis in LE which has not been reported in literature so far.
Ocular involvement may precede other systemic symptoms in SLE, so ophthalmologist should know about this rare simultaneous presentation. Ocular activity can correlate with systemic disease activity and starting early effective treatment can prevent other systemic lesion and can be life saving.
一名已知的系统性红斑狼疮（SLE）患者右眼突然失明（无光感）且伴有相对传入性瞳孔障碍，眼底检查显示在番茄酱样背景上有樱桃红斑，伴有迂曲扩张的静脉，提示视网膜中央动静脉联合阻塞。
左眼视力为6/6，但后极部显示视盘充血。眼底荧光血管造影（FFA）显示右眼臂-视网膜时间延迟及动静脉通过时间延长。左眼显示视盘周围染料潴留，提示与SLE相关的视神经炎。对患者进行重新评估，狼疮抗凝物检测呈阳性。患者被诊断为继发于SLE的抗磷脂抗体综合征（APS）。开始给予静脉注射类固醇、抗凝剂治疗，左眼病情进展得到控制。
我们报告了一种罕见的情况，即右眼视网膜中央动静脉完全联合阻塞（CCRAVO）与左眼视神经炎同时出现，这在文献中尚未见报道。
SLE患者眼部受累可能先于其他全身症状出现，因此眼科医生应了解这种罕见的同时出现的情况。眼部活动可与全身疾病活动相关，早期开始有效的治疗可预防其他全身病变，挽救生命。
