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Michelle K. Nguyen, Arash Mozayan, Vandana Minnal, Jamie Rosenberg, Irena Tsui; Peripheral Retinal Pruning in Systemic Lupus Erythematosus. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4263.
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Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disease which can manifest in the retina in a variety of forms from asymptomatic cotton wool spots and intraretinal hemorrhages to visually impairing optic disc vasculitis and occlusive retinal vasculitis.
Small case series reporting clinical presentation and ultra-wide-field fluorescein angiography (UWFFA, Optos, Marlborough, MA) in two patients with SLE.
Case 1: An 11-year-old female with newly diagnosed SLE presented with two episodes of transient visual obscuration. Vision acuity was 20/20 ou and dilated fundus exam (DFE) revealed several cotton wool spots ou.Case 2: A 25 year-old female with an exacerbation of lupus nephritis complained of transient blurry vision and diplopia. Visual acuity was 20/20 ou and DFE revealed mild heme and multiple pigment epithelial detachments in the macula OU.UWFFA Results: Peripheral retinal pruning was noted in three of four eyes (Picture). This finding was present in 22/33 (61%) UWFFA images, occurred from 26 seconds to 5.44 minutes, and was visible in the nasal and temporal quadrants only. Peripheral retinal pruning resolved during the recirculation phase.
Peripheral retinal pruning, typically seen in retinal microvascular diseases such as diabetic retinopathy and vein occlusions, is described in three eyes of two patients with active SLE. We hypothesize that these areas of peripheral retinal pruning represent slowed perfusion through terminal capillaries. Further research can be aimed at determining how this correlates to SLE disease activity and whether it would be beneficial to monitor peripheral retinal pruning as a response to systemic treatment.
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