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Review : Antiphospholipid antibodies and retinal vascular disease

Wilmer Ophthalmological Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine

SW Noorily

Wilmer Ophthalmological Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine

M. Petri

Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

D. Finkelstein

Wilmer Ophthalmological Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine

JT Rosenbaum

Casey Eye Institute, University of Oregon Health Sciences Center, Portland, OR, USA

DA Jabs

Wilmer Ophthalmological Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

Background. Antiphospholipid antibody retinopathy is a rare and poorly defined clinical entity in which the proper diagnosis has important ocular and systemic implications. The clinical course of five patients with antiphospholipid antibody retinopathy is described and the role of such antibodies in idiopathic retinal venous occlusive disease is investigated.

Methods. Five case reports are presented highlighting the presentation, course, therapy, associations and outcomes of patients with antiphospholipid antibody retinopathy. In addi tion, twenty additional patients presenting with idiopathic retinal venous occlusive disease were tested for the presence of antiphospholipid antibodies.

Results. All five patients with antiphospholipid antibody retinopathy had diffuse retinal vascular occlusion. All five patients presented with associated rheumatologic disease, includ ing three with lupus or lupus-like disease. Antibodies to antiphospholipid were not detected in any of the twenty patients with idiopathic retinal venous occlusive disease. Prompt pan- retinal photocoagulation together with varying regimens of corticosteroids, immunosup pressives, or warfarin was partially successful in stabilizing the ocular and systemic disease.

Conclusion. The diagnosis of antiphospholipid antibody retinopathy should be suspected in patients with diffuse retinal vaso-occlusion, particularly when characterized by involvement of both arteries and veins, neovascularization at presentation, and symptoms of systemic rheumatologic disease. Antiphospholipid antibodies do not appear to play an important role in idiopathic retinal vein occlusions.

Key Words: antiphospholipid antibody • lupus anticoagulant • retinal neovascularization • retinal vein occlusion • systemic lupus erythematosus

Lupus, Vol. 5, No. 4, 313-322 (1996)
DOI: 10.1177/096120339600500413


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