Multiple Retinal Arterial Occlusion and Retinal Vasculitis Associated With IgA Nephropathy

Seong Jae Kim; In Young Chung; Jong Moon Park

doi:10.3341/jkos.2009.50.12.1887

Journal List > J Korean Ophthalmol Soc > v.50(12) > 1008456

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Chung, and Park: Multiple Retinal Arterial Occlusion and Retinal Vasculitis Associated With IgA Nephropathy

Original Article

J Korean Ophthalmol Soc 2009;50(12):1887-1891.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.12.1887

Multiple Retinal Arterial Occlusion and Retinal Vasculitis Associated With IgA Nephropathy

Seong Jae Kim, MD¹, In Young Chung, MD^1,², Jong Moon Park, MD^1,²

¹Department of Ophthalmology, Gyeong Sang National University, College of Medicine, Jinju, Korea

²Gyeong Sang Institute of Health Science, Gyeongsang National University, Jinju, Korea

Address reprint requests to Jong Moon Park, MD, Department of Ophthalmology, College of Medicine, Gyeongsang National University #90 Chiram-dong, Jinju 660-702, Korea Tel: 82-55-750-8167, Fax: 82-55-758-4158, E-mail: parkjm@gnu.ac.kr

Received 10 March 2009 Accepted 8 September 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: IgA nephropathy, Retinal artery occlusion, Retinal vasculitis

References

1. Fauci AS, Braunwald E, Kasper DL, et al. Harrison's principles of internal medicine. 17th ed.2. New York: McGrow-Hill medical;2008. p. 1788–9.

2. Sinniah R. IgA mesangial nephropathy: Berger's disease. Am J Nephrol. 1985; 5:73–83.

3. André C, Berthoux FC, André F, et al. Prevalence of IgA2 deposit in IgA nephropathies: A clue to their pathogenesis. N Eng J Med. 1980; 303:1343–6.

4. Møller-Jensen J, Marthinsen L, Linné T. Anterior Uveitis in IgA Nephropathy. Am J Ophthalmol. 1989; 108:604–5.

5. Izzedine H, Bodaghi B, Launay-Vacher V, Deray G. Oculorenal manifestations in systemic autoimmune disease. Am J Kidney dis. 2004; 43:209–22.

6. Nomoto Y, Sakai H, Endoh M, Tomino Y. Scleritis and IgA Nephropathy. Arch Intern Med. 1980; 140:783–5.

7. Yamabe H, Ozawa K, Fukushi K. IgA nephropathy and henoch-schonlein purpura nephritis with anterior uveitis. Nephron. 1988; 50:368–70.

8. Hurault de Ligny B, Sirbat D, Bene MC, et al. Scleritis associated with glomerulonephritis. Nephron. 1983; 35:207.

9. Kaplan HJ, Waldrep JC. Immunologic insights into uveitis and retinitis: the immunoregulatory circuit. Ophthalmology. 1984; 91:655–65.

10. Pavlin CJ, Easterbrook M, Harasiewicz K, Foster FS. An ultrasound biomicroscopic analysis of angle-closure glaucoma secondary to ciliochoroidal effusion in IgA nephropathy. Am J Ophthalmol. 1993; 116:341–5.

11. Wolfensberger TJ, Piguer B, Gregor ZJ, Bird AC. Retinal vasculopathy associated with Berger's IgA Nephropathy. Klin Monatsbl Augenheilkd. 2000; 216:334–8.

12. Kim KJ, Kwak HW. A case of Choroiditis Associated with IgA Nephropathy. J Korean Ophthalmol Soc. 1987; 28:1095–9.

13. Kim SK, Kwon SK. Prepapillary vascular loops associated with branch retinal artery occlusion and vitreous hemorrhage. J Korean Ophthalmol Soc. 2007; 48:1001–6.

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).

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.

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).

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.

TOOLS

Similar articles