Case of the Month | July 2021

Case of the Month
July 27, 2021

The Case

The patient was a 33-year-old woman with a history of antiphospholipid syndrome who had no acute complaints and said that she had a few longstanding floaters in the right eye. She had a history of hypertension, kidney disease, and anemia. Her medications included prednisone 10 mg daily, Plaquenil 200 mg daily, and Lovenox 100 mg daily. Her visual acuity was 20/25 OD and 20/50 OS. On examination, the anterior chambers were unremarkable. The vitreous was quiet in both eyes.  There were pigmentary changes in both maculas. There was superotemporal neovascularization in the right eye as well as areas of atrophy and scarring that were more prominent in the right eye than the left eye.

What has happened with this patient? What treatment, if any, would you recommend?

This patient had antiphospholipid syndrome, an autoimmune disorder that predisposes to blood clots, that led to multiple branch retinal artery occlusions in both eyes. The fluorescein angiogram of the right eye revealed severe peripheral nonperfusion, particularly in the superotemporal quadrant, moderately severe superior foveal nonperfusion, and superotemporal neovascularization. The left eye also had severe nonperfusion and two areas of early neovascularization. Both eyes had atrophic areas, which were likely due to choroidal infarctions. The patient was already on anticoagulation therapy. We planned to do panretinal photocoagulation to the areas of peripheral nonperfusion, but the patient was lost to follow-up.

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This patient had antiphospholipid syndrome, an autoimmune disorder that predisposes to blood clots, that led to multiple branch retinal artery occlusions in both eyes. The fluorescein angiogram of the right eye revealed severe peripheral nonperfusion, particularly in the superotemporal quadrant, moderately severe superior foveal nonperfusion, and superotemporal neovascularization. The left eye also had severe nonperfusion and two areas of early neovascularization. Both eyes had atrophic areas, which were likely due to choroidal infarctions. The patient was already on anticoagulation therapy. We planned to do panretinal photocoagulation to the areas of peripheral nonperfusion, but the patient was lost to follow-up.

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