Central retinal vein occlusion: A patient with systemic sclerosis

Jelena Karadzic, Aleksandra Radosavljevic, Igor Kovacevic
2016 Vojnosanitetski Pregled  
Introduction. Scleroderma (systemic sclerosis) is a severe chronic connective tissue disease, which results in involvement of numerous internal organs. Changes in the eye are the consequences of organ-specific manifestations of scleroderma or adverse effects of immunosuppressive treatment applied. Case report. We reported a 42-year-old woman with systemic sclerosis and acute deterioration of vision in the left eye, with visual acuity 0.9. After thorough clinical examination, including
more » ... n angiography and optical coherence tomography, the diagnosis of nonischemic central retinal vein occlusion was made. Further biochemical, rheumatological and immunological investigation, apart from inactive systemic sclerosis, showed normal findings. Therefore, the cause of central retinal vein occlusion could only be attributed to the microvascular changes in systemic sclerosis. After three months, visual acuity deteriorated to 0.6 due to the development of cystoid macular edema. The patient received intravitreal injection of bevacizumab and after a single dose visual acuity improved to 0.9. After a 6month follow-up, macular edema resolved and visual acuity stabilized. Conclusion. According to our knowledge and current data from the literature, central retinal vein occlusion is a rare vision threatening manifestation of scleroderma. There are only few published case reports on central vein occlusion in scleroderma patients. Examination of the ocular fundus is recommended for evaluation of vascular disease in patients with systemic sclerosis. Uvod. Skleroderma (sistemska skleroza) je ozbiljna hronična bolest vezivnog tkiva, koja zahvata brojne unutrašnje organe. Promene u oku mogu da budu posledica organ-specifičnih manifestacija skleroderme ili se mogu javiti usled neželjenih efekata imunosupresivne terapije koja se koristi u lečenju. Prikaz bolesnika. U radu je prikazana 42-godišnja bolesnica sa dijagnozom sistemske skleroze i naglim pogoršanjem vida na levo oku (sa vidnom oštrinom 0,9). Nakon detaljnog kliničkog pregleda, uključujući fluoresceinsku angiografiju i optičku koherentnu tomografiju, postavljena je dijagnoza neishemične forme okluzije centralne vene retine. Dalja biohemijska, reumatološka i imunološka ispitivanja, osim inaktivne sistemske skleroze, pokazala su normalan nalaz. Stoga je utvrđeno da je jedini uzrok venske okluzije predstavljaju mikrovaskularne promene u sklopu sistemske skleroze. Nakon tri meseca, vidna oštrina levog oka se pogoršala na 0,6 usled razvoja cistoidnog makularnog edema. Bolesnica je primila intravitrealnu injekciju bevacizumaba i nakon samo jedne doze vidna oština se popravila na 0,9. Nakon šest meseci praćenja, makularni edem se povukao, a vidna oština je ostala nepromenjena. Zaključak. Prema našim saznanjima i uvidom u literaturu, okluzija centralne vene retine je retka manifestacija skleroderme, koja može da ugrozi funkciju vida. Postoji svega nekoliko objavljenih radova u kojima je prikazana centralna venska okluzija kod ovih bolesnika. Kod bolesnika sa sistemskom sklerozom preporučuje se pregled zadnjeg segmenta oka radi procene mogućih vaskularnih promena.
doi:10.2298/vsp141028073k pmid:29320621 fatcat:3chtron2grde5asd4njjiyzenu