Purchase this article with an account.
CE Araya-Munoz, G Lopezcarasa-Hernandez, RM Romero-Castro, C Amigo, JM Jimenez-Sierra; Antiphospholipid Syndrome Diagnosed by Ocular Vascular Occlusion as the First Clinical Manifestation: Report of Three Cases . Invest. Ophthalmol. Vis. Sci. 2002;43(13):499.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: To describe ocular vascular occlusion as the first manifestation of antiphospholipid syndrome. Antiphospholipid Syndrome (APS) is an autoimmune disease caused by antibodies targeted against protein-phospholipid complexes, which involves platelets, endothelium, thrombotic factors, prostacyclins, antithrombin, and proteins C and S. Antibodies interfere with anticoagulant factors, which leads to a hypercoagulable state. Among the most frequent clinical manifestations of APS are: systemic thrombosis, thrombocytopenia and recurrent fetal loss, being unusual to find ocular vascular occlusion (OVO) as a first manifestation. Method: Retrospective review of 3 cases of APS diagnosed between 1998 and 2001, in which OVO was the first manifestation. Diagnosis was made measuring anticardiolipin antibodies (IgM and IgG) and lupus anticoagulant titers. Results: Case 1: 25-year-old female with rheumatoid arthritis that presents with bilateral amaurosis fugax and afferent papillary defect in OD. Visual acuity (VA) was Hand Movement (HM) in OD and 20/100 in OS. Admission diagnosis: Central Retinal Artery Occlusion OU, APS and Lupus Erythematosus Systemicus. Case 2: 24-year-old male with high myopia and sudden onset of visual loss in OS. Admission diagnosis: Central Retinal Vein Occlusion OU, primary APS without systemic association. Case 3: 62-year-old male with chronic headache and bilateral amaurosis fugax with partial recovery to 20/80 in OS and HM in OD. Admission diagnosis: Choroidal occlusion OD, primary APS. 3 years later he develops subfoveal choroidal neovascularization in OS. All patients were evaluated by a rheumatologist, and received oral warfarin and prednisone in the acute period, improving clinically without systemic compromise. Conclusion: APS is associated with thrombotic phenomena which affect the ocular arterial and venous vasculature. It is important to discard APS in every patient (specially young ones) who presents with OVO or repeated amaurosis fugax episodes, due to its prevalence, potential consequences and effective response to treatment.
This PDF is available to Subscribers Only