J Korean Ophthalmol Soc.  2009 Dec;50(12):1887-1891. 10.3341/jkos.2009.50.12.1887.

Multiple Retinal Arterial Occlusion and Retinal Vasculitis Associated With IgA Nephropathy

• Kim SJ
• Chung IY
• Park JM

• KMID: 2213004
• DOI: http://doi.org/10.3341/jkos.2009.50.12.1887

Abstract

PURPOSE
To report a case of occlusion of multiple retinal arteries associated with retinal vasculitis-associated IgA nephropathy.
Case summary
A 37-year-old diagnosed with immunoglobulin A(IgA) nephropathy by renal biopsy four months prior was referred to an ophthalmologist complaining of visual impairment in her right eye. On physical examination, the patient's visual acuity was hand-movements in the right eye and 1.0 in the left eye. She had relative afferent papillary defect in the right eye with cells in the anterior chamber. She was diagnosed with occlusion of multiple retinal arteries and retinal vasculitis on fundus examination and fluorescein angiogram. There were no abnormal findings on routine hematologic tests including thrombophilia studies, carotid artery, or cardiovascular examination. Antinuclear antibody, rheumatoid factor, and antiphospholipid antibody were negative.
CONCLUSIONS
The patient was diagnosed with retinal artery occlusion combined with retinal vasculitis associated with IgA nephropathy.

Keyword

IgA nephropathy; Retinal artery occlusion; Retinal vasculitis

MeSH Terms

Adult
Anterior Chamber
Antibodies, Antinuclear
Antibodies, Antiphospholipid
Biopsy
Carotid Arteries
Eye
Fluorescein
Glomerulonephritis, IGA
Hematologic Tests
Humans
Immunoglobulin A
Immunoglobulins
Physical Examination
Retinal Artery
Retinal Artery Occlusion
Retinal Vasculitis
Retinaldehyde
Rheumatoid Factor
Thrombophilia
Vision Disorders
Visual Acuity
Antibodies, Antinuclear
Antibodies, Antiphospholipid
Fluorescein
Immunoglobulin A
Immunoglobulins
Retinaldehyde
Rheumatoid Factor

Figure

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  Figure 1. Fundus photograph of both eyes at the first examination. Prominent arteriolar narrowing and multiple retinal hemorrhages and cotton-wool spots can be seen in the retina (A, B). Visual fields were within normal limit (C). RNFL thickness in glaucoma OCT is normal in both eye (D).

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  Figure 2. (A) Immunofluorescein examination of kidney biopsy shows accumulation of IgA in mesangeal matrix. (B) Electromicroscopic examination shows electron-dense deposit in the mesangium and patchy area of epithelial foot process effacement.

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  Figure 3. Four months after the intial examination, fundus photograph of the eye shows multiple retinal hemorrhages, obstruction of multiple retinal arteries and ischemic changes of the retina (A). OCT of right eye shows submacular exudation (B).

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  Figure 4. Fluorescein angiogram of the right fundus shows marked delay of filling in the early arterial phase and arteriovenous transit time at the macular and superotemporal area, and severe perivascular fluorescent leakage.

Reference

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