J Korean Ophthalmol Soc.  2016 May;57(5):847-852. 10.3341/jkos.2016.57.5.847.

A Case of Focal Laser Photocoagulation Added to Systemic Immunomodulatory Therapy for Bilateral Lupus Chorioretinopathy

• Kim DG
• Yoon CK
• Kim HW

• KMID: 2212731
• DOI: http://doi.org/10.3341/jkos.2016.57.5.847

Abstract

PURPOSE
To report a patient diagnosed with bilateral lupus chorioretinopathy who received focal laser photocoagulation.
CASE SUMMARY
A 20-year-old female presented with decreased vision in her left eye. She had been treated with systemic corticosteroids, immunosuppressants, plasmapheresis and hemodialysis during systemic lupus erythematosus flare-up. Retinal hemorrhage and cotton wool spots were observed in both eyes on funduscopic examination. Optical coherence tomography showed bilateral serous retinal detachment. Flurorescein angiography (FA) revealed multiple leakages of dye in both maculae. Despite improvements of the systemic disease, subretinal fluid was not resolved. Focal laser photocoagulation was applied to multiple leakage spots identified on FA in both eyes and serous detachment improved. After several months, additional focal laser photocoagulation was performed because there was a small amount of subretinal fluid, which was completely resolved.

Keyword

Chorioretinopathy; Choroidopathy; Focal laser photocoagulation; Systemic lupus erythematosus

MeSH Terms

Adrenal Cortex Hormones
Angiography
Female
Humans
Immunomodulation*
Immunosuppressive Agents
Light Coagulation*
Lupus Erythematosus, Systemic
Plasmapheresis
Renal Dialysis
Retinal Detachment
Retinal Hemorrhage
Subretinal Fluid
Tomography, Optical Coherence
Wool
Young Adult
Adrenal Cortex Hormones
Immunosuppressive Agents

Figure

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  Figure 1. Color fundus photography and optical coherence tomography (OCT) of 20-year old female during the first examination. Color fundus photography showing multiple flame-shaped retinal hemorrhage and cotton-wool spots (A, B). OCT revealed a small amount of subretinal fluid and retinal nerve fiber layer thickening in the right eye (C) and macular edema with serous retinal detachment in the left eye (D).

• 

  Figure 2. Ocular examinations at 2 days after first visit. (A-D) Inferior bullous retinal detachment was observed in both eyes. (E) Optical coherence tomography reveal macular edema and subretinal fluid increment in the right eye. (F) Submacular fluid in the left eye decreased slightly. (G, H) Fluorescein angiography shows multifocal areas of leakage with pooling in perivascular lesion in both eyes.

• 

  Figure 3. Anatomic changes after focal laser photocoagulation in optical coherence tomography. A week after the first focal laser photocoagulation, subretinal fluid was reduced (A, B). After 2 months, there was no further decrease of subretinal fluid (C, D) and additional focal laser photocoagulation was performed. A month after the second focal laser photocoagulation, remission of serous retinal detachment was observed (E, F).

Reference

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