J Rheum Dis.  2016 Oct;23(5):326-331. 10.4078/jrd.2016.23.5.326.

A Case of a Central Retinal Artery Occlusion in a Patient with Rheumatoid Arthritis

• Park EK
• Lee SG
• Koo DW
• Park JH
• Seol YM
• Lee S
• Lee SH
• Kim IS
• Park S

• KMID: 2356489
• DOI: http://doi.org/10.4078/jrd.2016.23.5.326

Abstract

A 50-year-old woman, who had been treated for rheumatoid arthritis (RA) over a 10-year period, suddenly presented with monocular vision loss while the RA had a stable course over many years. She was diagnosed with central retinal artery occlusion (CRAO) based on ophthalmologic examinations including optical coherence tomography and fluorescein angiography. There was no evidence of atherosclerosis, infection, and malignancy that can cause CRAO. Considering the association between CRAO and other rheumatic diseases, such as systemic vasculitis and systemic lupus erythematous in previous reports, it was presumed that her RA might have contributed to the development of CRAO. Although cases of CRAO in patients with RA are extremely rare, these findings suggest that physicians need to be aware of the possibility of CRAO in patients with RA who experience decreased visual acuity.

Keyword

Retinal artery occlusion; Rheumatoid arthritis

MeSH Terms

Arthritis, Rheumatoid*
Atherosclerosis
Female
Fluorescein Angiography
Humans
Middle Aged
Retinal Artery Occlusion*
Retinal Artery*
Rheumatic Diseases
Systemic Vasculitis
Tomography, Optical Coherence
Vision, Monocular
Visual Acuity

Figure

• 

  Figure 1. Clinical course of the patient during her 10-year follow-up period. CRAO: central retinal artery occlusion, CRP: C-re-active protein, ESR: erythrocyte sedimentation rate.

• 

  Figure 2. Fundoscopic findings. (A) A photograph of the right eye's fundus reveals no specific findings. (B) A photograph of the left eye's fundus reveals acute central retinal artery occlusion with cherry-red spots that were caused by a retinal infarction and arte-riole cattle trucking. No definite emboli were observed.

• 

  Figure 3. Optical coherence tomography (OCT) shows cross-section images of retina. (A) OCT of the right eye shows normal appearance. (B) OCT of the left eye shows the inner retina layer (nerve fiber layer) infarct presented as thickening and whitening (red arrows).

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  Figure 4. Fluorescein angiography at the onset of the central retinal artery occlusion. (A) Arterial filling in the left eye was markedly delayed in the early phase. (B) The arteriovenous transit time was prolonged with no venous flow in the middle phase. (C) Fluorescein pooling is visible in the late phase.

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