J Korean Ophthalmol Soc.  2017 Oct;58(10):1205-1210. 10.3341/jkos.2017.58.10.1205.

Bilateral Macular Infarction in Primary Antiphospholipid Syndrome

Affiliations
  • 1Department of Ophthalmology, Chosun University College of Medicine, Gwangju, Korea. s20age@hanmail.net

Abstract

PURPOSE
We report a rare case of bilateral macular infarction as an ocular presenting sign of primary antiphospholipid syndrome.
CASE SUMMARY
A 29-year-old woman who had undergone a cesarean section for chorioamnionitis in the department of Obsterics was referred to the department of ophthalmology for bilateral visual loss. At examination, best-corrected visual acuity (BCVA) of the right eye was counting fingers, and for the left was 0.05. Fundus examination revealed extensive macular edema and cotton-wool spots in both eyes. We performed hematologic tests including thrombophilia examination. Antinuclear antibody and rheumatoid factor were negative but lupus anticoagulant presented high titers on two occasions 12 weeks apart. She was administered sub-Tenon's injections of triamcinolone acetonide 50 mg/week in both eyes under the diagnosis of bilateral macular arteriolar occlusion in primary antiphospholipid syndrome. Her BCVA remained 0.025 in her right eye and improved to 0.125 in her left eye.
CONCLUSIONS
Macular infarction is an uncommon but severe complication of antiphospholipid syndrome. Early and regular fundus exam in patients with antiphospholipid syndrome is necessary to avoid progression of severe ocular complications.

Keyword

Antiphospholipid syndrome; Macular infarction

MeSH Terms

Adult
Antibodies, Antinuclear
Antiphospholipid Syndrome*
Cesarean Section
Chorioamnionitis
Diagnosis
Female
Fingers
Hematologic Tests
Humans
Infarction*
Lupus Coagulation Inhibitor
Macular Edema
Ophthalmology
Pregnancy
Rheumatoid Factor
Thrombophilia
Triamcinolone Acetonide
Visual Acuity
Antibodies, Antinuclear
Lupus Coagulation Inhibitor
Rheumatoid Factor
Triamcinolone Acetonide

Figure

  • Figure 1 Fundus photographs showed confluent macular cotton wool spots and retinal ischemic edema presenting like cheery-red spots and intraretinal hemorrhages. (A) Right eye. (B) Left eye.

  • Figure 2 Fluorescein angiographs showed extensive macular capillary non-perfusion and blocked hypofluorescence due to inner retinal edema. (A) Early-phase; Right eye. (B) Early-phase; Left eye. (C) Late-phase; Right eye. (D) Late-phase; Left eye.

  • Figure 3 Ocular coherence tomography scans showed localized inner retinal swelling in both eyes. (A) Right eye. (B) Left eye.


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