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Park, Lee, Koo, Park, Seol, Lee, Lee, Kim, and Park: A Case of a Central Retinal Artery Occlusion in a Patient with Rheumatoid Arthritis
Case Report

J Rheum Dis 2016;23(5):326-331.

Published online: 31 October 2016

DOI: https://doi.org/10.4078/jrd.2016.23.5.326

A Case of a Central Retinal Artery Occlusion in a Patient with Rheumatoid Arthritis

Eun-Kyoung Park1, Seung-Geun Lee1, Dong-Wan Koo1, Ji-Heh Park1, Young-Mi Seol2, Shinwon Lee3, Sun-Hack Lee1, In-Su Kim1, Sungwho Park4

1Division of Rheumatology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea

2Division of Hemato-oncology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea

3Department of Internal Medicine, Pusan National University Hospital, Medical Research Institute, Pusan National University School of Medicine, Busan, Korea

4Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea

Corresponding to: Seung-Geun Lee, Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea. E-mail: sglee@pnuh.co.kr

Received 5 February 201611 March 2016       Accepted 7 April 2016

Copyright © 2016 The Korean College of Rheumatology

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 50-year-old woman, who had been treated for rheumatoid arthritis (RA) over a 10-year period, suddenly presented with mon-ocular vision loss while the RA had a stable course over many years. She was diagnosed with central retinal artery occlusion (CRAO) based on ophthalmologic examinations including optical coherence tomography and fluorescein angiography. There was no evidence of atherosclerosis, infection, and malignancy that can cause CRAO. Considering the association between CRAO and other rheumatic diseases, such as systemic vasculitis and systemic lupus erythematous in previous reports, it was presumed that her RA might have contributed to the development of CRAO. Although cases of CRAO in patients with RA are extremely rare, these findings suggest that physicians need to be aware of the possibility of CRAO in patients with RA who experience decreased visual acuity.

Keywords: Retinal artery occlusion, Rheumatoid arthritis

REFERENCES

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Figure 1.
Clinical course of the patient during her 10-year follow-up period. CRAO: central retinal artery occlusion, CRP: C-re-active protein, ESR: erythrocyte sedimentation rate.
jrd-23-326f1.tif
Figure 2.
Fundoscopic findings. (A) A photograph of the right eye's fundus reveals no specific findings. (B) A photograph of the left eye's fundus reveals acute central retinal artery occlusion with cherry-red spots that were caused by a retinal infarction and arte-riole cattle trucking. No definite emboli were observed.
jrd-23-326f2.tif
Figure 3.
Optical coherence tomography (OCT) shows cross-section images of retina. (A) OCT of the right eye shows normal appearance. (B) OCT of the left eye shows the inner retina layer (nerve fiber layer) infarct presented as thickening and whitening (red arrows).
jrd-23-326f3.tif
Figure 4.
Fluorescein angiography at the onset of the central retinal artery occlusion. (A) Arterial filling in the left eye was markedly delayed in the early phase. (B) The arteriovenous transit time was prolonged with no venous flow in the middle phase. (C) Fluorescein pooling is visible in the late phase.
jrd-23-326f4.tif
Table 1.
Cases of central retinal artery occlusion in rheumatoid arthritis
Author [Reference] Age (yr)/sex Cause of CRAO Treatment Nationality Year of publication
Matsuo [8] 67/F Vascular inflammation, rheumatoid vasculitis Hyperbaric oxygen, intravenous prostaglandin E1, urokinase Japan 2001
Kachmaryk et al. [9] 49/F Sickle cell trait, hypergammaglobulinemia Not mentioned USA 1995
Park et al.(present study) 50/F Not clearly defined, may be inflammatory Conservative, oral antiplatelet agent Korea 2016

CRAO: central retinal artery occlusion, F: female.

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