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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 BMC+Ophthalmol
2015 ; 15
(ä): 148
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Secondary angle closure glaucoma by lupus choroidopathy as an initial
presentation of systemic lupus erythematosus: a case report
#MMPMID26511325
Han YS
; min Yang C
; Lee SH
; Shin JH
; Moon SW
; Kang JH
BMC Ophthalmol
2015[Oct]; 15
(ä): 148
PMID26511325
show ga
BACKGROUND: We present a rare case of secondary angle closure glaucoma due to
systemic lupus erythematosus choroidopathy as initial presentation of systemic
lupus erythematosus, accompanied by central nervous system vasculitis and
uncontrolled nephropathy. CASE PRESENTATION: A 31-year-old woman presented with
decreased visual acuity, nausea, vomiting, fever, and bilateral angioedema-like
eyelid swelling. She had persistent dry cough while taking medication for 3
months, and had usual posterior neck pain, which was treated with analgesic
medication and Asian medicines. Intraocular pressure was 32 and 34 mmHg in her
right and left eyes, respectively. Peripheral anterior chambers were shallow
(grade I) using the van Herick method. Gonioscopy revealed 360° closed angle in
both eyes. In both eyes, serous retinal detachment was found using optical
coherence tomography and B scan ultrasonography, as well as choroidal thickening
with effusion. Secondary acute angle closure glaucoma was drug induced, or caused
by uveitis of unknown etiology when she was first treated with intraocular
pressure-lowering medication. During evaluation of the drug-induced angioedema in
the internal medicine department, systemic lupus erythematosus was diagnosed,
based on malar rash, photosensitivity, proteinuria, and positive anti-Smith and
anti-DNA antibodies, followed by initiation of steroid pulse therapy. Using
fluorescein angiography, multifocal subretinal pinpoint foci were detected at the
middle phase. We then diagnosed bilateral angle closure glaucoma by choroidal
effusions, with lupus choroidopathy. At 2 months after steroid pulse therapy,
subretinal fluid was not found, and visual acuity improved to normal. During the
subsequent 2 years, lupus choroidopathy was not aggravated but lupus nephritis
was not controlled. CONCLUSION: Patients with systemic lupus erythematosus
choroidopathy can develop ciliochoroidal effusion, which can lead to acute angle
closure glaucoma. Systemic lupus erythematosus choroidopathy is an early sign of
severe complications. Angle closure glaucoma by systemic lupus erythematosus
choroidopathy can be effectively treated using antiglaucoma drugs and
immunosuppressive therapy.