Jalilzadeh R., Weinand F.

Zentrum für Augenheilkunde der Universität Gießen, Friedrichstraße 18, D- 35385 Gießen

Systemic lupus erythematodes (SLE) is an autoimmune disease of unknown aetiology. Ocular manifestations involve the lid, conjunctiva, choroid, retina and optic nerve. Retinal vasculitis is the most common affection. Despite therapy it may lead to massive visual loss due to ischemia. In such patients maximal immunosuppressive therapy is usually applied.
Case report: In August 2000 a 51 year old woman attended our clinic with acute visual loss and blurred vision since 5 days. She reported a 1,5 year history of systemic vasculitis in suspected lupus erythemotodes with polyneuropathy and secondary hypertension. Vision at presentation was 1.0 in her right eye and 0.3 in her left eye. Fundus showed a retinal vasculitis with cotton wool spots and intraretinal bleedings with involvement of the macula in her left eye. We increased her corticosteroid medication from 4 mg/die on 100 mg/die. Fluorescein angiography was performed.
Results: Despite high dose corticosteroid therapy vision deteriorated to 0.3 in both eyes. Two weeks after onset of therapy the patient got acute renal failure requiring dialysis. Renal biopsy showed necrotic vasculitis. Patient was hospitalised and set on cyclophosphamide and prednisolone (each 100 mg/die). Additionally a plasmapheresis was performed. This led to fast improvement of vasculitis and renal function. In January 2001 neither cotton wool spots nor intraretinal bleedings were found and vision improved to 0.8 in her right and 0.5 in her left eye. Since then situation stabilised on 20mg/die prednisolone.
Conclusion: In systemic lupus erythematodes vascular retinopathy may cause visual loss. Early immunosuppressive therapy and additionally a plasmapheresis in the acute phase may influence a favourable outcome.

Copyright © Deutsche Ophthalmologische Gesellschaft, 2001. All rights reserved.

Last updated: 

Webdesign: SPALLEK.COM