Central Retinal Artery and Vein Occlusion
A 17-year-old girl presented to the ophthalmology clinic with a 2-day history of decreased vision in her right eye and a 6-month history of intermittent headaches. Four years before presentation, she had received a diagnosis of systemic lupus erythematosus (SLE). She had been receiving treatment that included methylprednisolone and hydroxychloroquine until 2 years before presentation, when she stopped taking these medications and began treatment with traditional Chinese medicine. At presentation, her best corrected visual acuity was light perception in the right eye and 20/20 in the left eye. Mydriasis was noted in the right pupil, which was not reactive to light. Examination of the fundus of the right eye revealed disk edema, severe arteriolar attenuation, dilated and tortuous retinal veins, extensive superficial and deep intraretinal hemorrhages, retinal pallor, and a cherry-red spot in the macula. Laboratory studies showed positivity for antinuclear antibody, anti–double-stranded DNA antibody, and lupus anticoagulant, as well as an elevated erythrocyte sedimentation rate and decreased serum complement levels. Positivity for lupus anticoagulant was again found on repeat testing 12 weeks later. Central retinal artery and vein occlusion due to SLE-associated antiphospholipid syndrome was diagnosed. Despite treatment that included immunosuppression and anticoagulation, the patient’s vision had not improved after 1 month.