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Secondary angle closure glaucoma by lupus choroidopathy as an initial presentation of systemic lupus erythematosus: a case report.

Han YS, min Yang C, Lee SH, Shin JH, Moon SW, Kang JH - BMC Ophthalmol (2015)

Bottom Line: In both eyes, serous retinal detachment was found using optical coherence tomography and B scan ultrasonography, as well as choroidal thickening with effusion.At 2 months after steroid pulse therapy, subretinal fluid was not found, and visual acuity improved to normal.Angle closure glaucoma by systemic lupus erythematosus choroidopathy can be effectively treated using antiglaucoma drugs and immunosuppressive therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Graduate School, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Korea. hyis2428@daum.net.

ABSTRACT

Background: 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.

Case presentation: 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.

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus

Fluorescein angiography (FAG) at the initial visit. Multifocal subretinal pinpoint foci were detected at the middle phase, and serous elevation was detected at the late phase in both eyes
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Fig5: Fluorescein angiography (FAG) at the initial visit. Multifocal subretinal pinpoint foci were detected at the middle phase, and serous elevation was detected at the late phase in both eyes

Mentions: She returned 5 days later with increasing periorbital swelling, severe conjunctival chemosis, orthopnea, coughing, and headache. Chest computed tomography revealed bilateral pleural effusion and atelectasis. Cardiac sonography showed pericardial effusion. Using a brain MRI, SLE vasculitis was found in the thalamus and basal ganglia. She was treated with thoracocentesis that showed exudates, and also treated with high doses of intravenous methylprednisolone (1 g). At this time, IOP in both eyes was 18 mmHg with medication, and the peripheral anterior chamber was deepened. Using OCT, decreased serous retinal detachment was found in both eyes (Fig. 4). Using fluorescein angiography (FAG), multifocal subretinal pinpoint foci were detected at the middle phase, and serous elevation was detected at the late phase (Fig. 5). The diagnosis was changed to secondary angle closure glaucoma by choroidal effusion with lupus choroidopathy. After steroid pulse therapy, the patient’s systemic symptom was relieved, so she was discharged with a prescription of 60 mg prednisolone and 200 mg hydroxychloroquine.Fig. 4


Secondary angle closure glaucoma by lupus choroidopathy as an initial presentation of systemic lupus erythematosus: a case report.

Han YS, min Yang C, Lee SH, Shin JH, Moon SW, Kang JH - BMC Ophthalmol (2015)

Fluorescein angiography (FAG) at the initial visit. Multifocal subretinal pinpoint foci were detected at the middle phase, and serous elevation was detected at the late phase in both eyes
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4625431&req=5

Fig5: Fluorescein angiography (FAG) at the initial visit. Multifocal subretinal pinpoint foci were detected at the middle phase, and serous elevation was detected at the late phase in both eyes
Mentions: She returned 5 days later with increasing periorbital swelling, severe conjunctival chemosis, orthopnea, coughing, and headache. Chest computed tomography revealed bilateral pleural effusion and atelectasis. Cardiac sonography showed pericardial effusion. Using a brain MRI, SLE vasculitis was found in the thalamus and basal ganglia. She was treated with thoracocentesis that showed exudates, and also treated with high doses of intravenous methylprednisolone (1 g). At this time, IOP in both eyes was 18 mmHg with medication, and the peripheral anterior chamber was deepened. Using OCT, decreased serous retinal detachment was found in both eyes (Fig. 4). Using fluorescein angiography (FAG), multifocal subretinal pinpoint foci were detected at the middle phase, and serous elevation was detected at the late phase (Fig. 5). The diagnosis was changed to secondary angle closure glaucoma by choroidal effusion with lupus choroidopathy. After steroid pulse therapy, the patient’s systemic symptom was relieved, so she was discharged with a prescription of 60 mg prednisolone and 200 mg hydroxychloroquine.Fig. 4

Bottom Line: In both eyes, serous retinal detachment was found using optical coherence tomography and B scan ultrasonography, as well as choroidal thickening with effusion.At 2 months after steroid pulse therapy, subretinal fluid was not found, and visual acuity improved to normal.Angle closure glaucoma by systemic lupus erythematosus choroidopathy can be effectively treated using antiglaucoma drugs and immunosuppressive therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Graduate School, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Korea. hyis2428@daum.net.

ABSTRACT

Background: 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.

Case presentation: 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.

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus