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Kim, Yoon, and Kim: Bilateral Macular Infarction in Primary Antiphospholipid Syndrome
Case Report

Journal of the Korean Ophthalmological Society 2017; 58(10): 1205-1210.

Published online: 11 October 2017

DOI: https://doi.org/10.3341/jkos.2017.58.10.1205

Bilateral Macular Infarction in Primary Antiphospholipid Syndrome

Hyun Ju Kim, MD, Han Gyul Yoon, MD, Seong Taeck Kim, MD, PhD

Department of Ophthalmology, Chosun University College of Medicine, Gwangju, Korea.

Address reprint requests to Seong Taeck Kim, MD, PhD. Department of Ophthalmology, Chosun University Hospital, #365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea. Tel: 82-62-220-3190, Fax: 82-62-225-9839, s20age@hanmail.net

Received 1 June 2017       Revised 30 August 2017       Accepted 24 September 2017

©2017 The Korean Ophthalmological Society

The Korean Ophthalmological Society

(open-access):

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

We report a rare case of bilateral macular infarction as an ocular presenting sign of primary antiphospholipid syndrome.

Case summary

A 29-year-old woman who had undergone a cesarean section for chorioamnionitis in the department of Obsterics was referred to the department of ophthalmology for bilateral visual loss. At examination, best-corrected visual acuity (BCVA) of the right eye was counting fingers, and for the left was 0.05. Fundus examination revealed extensive macular edema and cotton-wool spots in both eyes. We performed hematologic tests including thrombophilia examination. Antinuclear antibody and rheumatoid factor were negative but lupus anticoagulant presented high titers on two occasions 12 weeks apart. She was administered sub-Tenon's injections of triamcinolone acetonide 50 mg/week in both eyes under the diagnosis of bilateral macular arteriolar occlusion in primary antiphospholipid syndrome. Her BCVA remained 0.025 in her right eye and improved to 0.125 in her left eye.

Conclusions

Macular infarction is an uncommon but severe complication of antiphospholipid syndrome. Early and regular fundus exam in patients with antiphospholipid syndrome is necessary to avoid progression of severe ocular complications.

Keywords: Antiphospholipid syndrome, Macular infarction

Figures and Tables

Figure 1

Fundus photographs showed confluent macular cotton wool spots and retinal ischemic edema presenting like cheery-red spots and intraretinal hemorrhages. (A) Right eye. (B) Left eye.

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Figure 2

Fluorescein angiographs showed extensive macular capillary non-perfusion and blocked hypofluorescence due to inner retinal edema. (A) Early-phase; Right eye. (B) Early-phase; Left eye. (C) Late-phase; Right eye. (D) Late-phase; Left eye.

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Figure 3

Ocular coherence tomography scans showed localized inner retinal swelling in both eyes. (A) Right eye. (B) Left eye.

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Notes

Conflicts of Interest The authors have no conflicts to disclose.

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