PDF(Pubmed)
Abstract：
OBJECTIVE: To report anterior chamber flare using laser flare photometry and ciliochoroidal detachment using anterior segment optical coherence tomography (AS-OCT) in a new onset acute lupus choroidopathy case.
METHODS: A 57-year-old woman with severe nephritis, pleural effusion, and ascites was referred to our ophthalmology clinic for rapid onset of bilateral blurred vision and eyelid swelling. She had a bilateral high-flared, shallow anterior chamber, and bilateral ciliochoroidal detachment, which was revealed using laser flare photometry and AS-OCT. She also had a serous retinal detachment and disc-macular retinoschisis with a thicker choroid and waved Bruch\'s membrane. Indocyanine green angiography (ICGA) demonstrated partial hypocyanescence in the early phase and multiple hypercyanescent spots at the intermediate to late phase, which are typical of lupus choroidopathy. Systemic lupus erythematosus was diagnosed, and after the administration of pulse methylprednisolone and pulse cyclophosphamide therapies, all eye findings completely resolved in a month, and all other signs and symptoms improved.
CONCLUSIONS: Lupus choroidopathy, which is less common than retinopathy, might be under-diagnosed because of its difficult evaluation. Although ICGA is the gold standard for diagnosing lupus choroidopathy, a high flare of the anterior chamber and ciliochoroidal detachment might be different from lupus retinopathy. Laser flare photometry and AS-OCT can be non-invasive, helpful tools for the longitudinal evaluation of the patient\'s response to therapy.
METHODS: A 57-year-old woman with severe nephritis, pleural effusion, and ascites was referred to our ophthalmology clinic for rapid onset of bilateral blurred vision and eyelid swelling. She had a bilateral high-flared, shallow anterior chamber, and bilateral ciliochoroidal detachment, which was revealed using laser flare photometry and AS-OCT. She also had a serous retinal detachment and disc-macular retinoschisis with a thicker choroid and waved Bruch\'s membrane. Indocyanine green angiography (ICGA) demonstrated partial hypocyanescence in the early phase and multiple hypercyanescent spots at the intermediate to late phase, which are typical of lupus choroidopathy. Systemic lupus erythematosus was diagnosed, and after the administration of pulse methylprednisolone and pulse cyclophosphamide therapies, all eye findings completely resolved in a month, and all other signs and symptoms improved.
CONCLUSIONS: Lupus choroidopathy, which is less common than retinopathy, might be under-diagnosed because of its difficult evaluation. Although ICGA is the gold standard for diagnosing lupus choroidopathy, a high flare of the anterior chamber and ciliochoroidal detachment might be different from lupus retinopathy. Laser flare photometry and AS-OCT can be non-invasive, helpful tools for the longitudinal evaluation of the patient\'s response to therapy.
摘要：
目的：在新发病的急性狼疮脉络膜病变病例中，使用激光耀斑测光法进行前房耀斑和使用眼前节光学相干断层扫描（AS-OCT）进行纤毛脉络膜脱离。
方法：一名57岁的重度肾炎女性，胸腔积液,腹水被转诊到我们的眼科诊所，因为双侧视力模糊和眼睑肿胀的快速发作。她有一个双侧高爆发，浅前房,双侧纤毛脉络膜脱离,使用激光耀斑测光和AS-OCT显示。她还患有浆液性视网膜脱离和椎间盘黄斑视网膜裂隙，脉络膜较厚，布鲁赫膜呈波浪状。吲哚菁绿血管造影术（ICGA）在早期阶段显示出部分的低氰化，在中期至晚期阶段显示出多个高氰化点，这是典型的狼疮脉络膜病变。诊断出系统性红斑狼疮,在脉冲甲基强的松龙和脉冲环磷酰胺治疗后，所有的眼睛发现在一个月内完全解决，所有其他体征和症状都有所改善。
结论：狼疮脉络膜病变，比视网膜病变更不常见，可能由于难以评估而被诊断不足。虽然ICGA是诊断狼疮脉络膜病变的金标准,前房的高度耀斑和脉络膜脱离可能与狼疮视网膜病变不同。激光耀斑测光和AS-OCT可以是非侵入性的，纵向评估患者对治疗反应的有用工具。
方法：一名57岁的重度肾炎女性，胸腔积液,腹水被转诊到我们的眼科诊所，因为双侧视力模糊和眼睑肿胀的快速发作。她有一个双侧高爆发，浅前房,双侧纤毛脉络膜脱离,使用激光耀斑测光和AS-OCT显示。她还患有浆液性视网膜脱离和椎间盘黄斑视网膜裂隙，脉络膜较厚，布鲁赫膜呈波浪状。吲哚菁绿血管造影术（ICGA）在早期阶段显示出部分的低氰化，在中期至晚期阶段显示出多个高氰化点，这是典型的狼疮脉络膜病变。诊断出系统性红斑狼疮,在脉冲甲基强的松龙和脉冲环磷酰胺治疗后，所有的眼睛发现在一个月内完全解决，所有其他体征和症状都有所改善。
结论：狼疮脉络膜病变，比视网膜病变更不常见，可能由于难以评估而被诊断不足。虽然ICGA是诊断狼疮脉络膜病变的金标准,前房的高度耀斑和脉络膜脱离可能与狼疮视网膜病变不同。激光耀斑测光和AS-OCT可以是非侵入性的，纵向评估患者对治疗反应的有用工具。
