A Case of Focal Laser Photocoagulation Added to Systemic Immunomodulatory Therapy for Bilateral Lupus Chorioretinopathy

Dong Geun Kim; Chang Ki Yoon; Hyun Woong Kim

doi:10.3341/jkos.2016.57.5.847

Journal List > J Korean Ophthalmol Soc > v.57(5) > 1010598

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Kim, Yoon, and Kim: A Case of Focal Laser Photocoagulation Added to Systemic Immunomodulatory Therapy for Bilateral Lupus Chorioretinopathy

Case Report

J Korean Ophthalmol Soc 2015;57(5):847-852.

Published online: 7 September 2015

DOI: https://doi.org/10.3341/jkos.2016.57.5.847

A Case of Focal Laser Photocoagulation Added to Systemic Immunomodulatory Therapy for Bilateral Lupus Chorioretinopathy

Dong Geun Kim, MD, Chang Ki Yoon, MD, Hyun Woong Kim, MD, PhD

Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

Address reprint requests to Hyun Woong Kim, MD, PhD Department of Ophthalmology, Inje University Busan Paik Hospital, #75 Bokji-ro, Busanjin-gu, Busan 47392, Korea Tel: 82-51-890-6016, Fax: 82-51-890-6329 E-mail: maekbak@hanmail.net

Received 12 November 20153 February 2016 Accepted 27 March 2016

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 perm its unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a patient diagnosed with bilateral lupus chorioretinopathy who received focal laser photocoagulation.

Case summary

A 20-year-old female presented with decreased vision in her left eye. She had been treated with systemic corticosteroids, immunosuppressants, plasmapheresis and hemodialysis during systemic lupus erythematosus flare-up. Retinal hemorrhage and cotton wool spots were observed in both eyes on funduscopic examination. Optical coherence tomography showed bilateral serous retinal detachment. Flurorescein angiography (FA) revealed multiple leakages of dye in both maculae. Despite improvements of the systemic disease, subretinal fluid was not resolved. Focal laser photocoagulation was applied to multiple leakage spots identified on FA in both eyes and serous detachment improved. After several months, additional focal laser photocoagulation was performed because there was a small amount of subretinal fluid, which was completely resolved.

Keywords: Chorioretinopathy, Choroidopathy, Focal laser photocoagulation, Systemic lupus erythematosus

References

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Figure 1.

Color fundus photography and optical coherence tomography (OCT) of 20-year old female during the first examination. Color fundus photography showing multiple flame-shaped retinal hemorrhage and cotton-wool spots (A, B). OCT revealed a small amount of subretinal fluid and retinal nerve fiber layer thickening in the right eye (C) and macular edema with serous retinal detachment in the left eye (D).

Figure 2.

Ocular examinations at 2 days after first visit. (A-D) Inferior bullous retinal detachment was observed in both eyes. (E) Optical coherence tomography reveal macular edema and subretinal fluid increment in the right eye. (F) Submacular fluid in the left eye decreased slightly. (G, H) Fluorescein angiography shows multifocal areas of leakage with pooling in perivascular lesion in both eyes.

Figure 3.

Anatomic changes after focal laser photocoagulation in optical coherence tomography. A week after the first focal laser photocoagulation, subretinal fluid was reduced (A, B). After 2 months, there was no further decrease of subretinal fluid (C, D) and additional focal laser photocoagulation was performed. A month after the second focal laser photocoagulation, remission of serous retinal detachment was observed (E, F).

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