Unusual presentation of CREST retinal vasculitis

Area of Science:

• Ophthalmology
• Rheumatology
• Immunology

Background:

• CREST syndrome, a variant of systemic sclerosis, can manifest with diverse systemic and ocular complications.
• Retinal vasculitis is a known but rare ocular manifestation of autoimmune diseases.
• Micropulse cyclophotocoagulation (mTS-CPC) is a therapeutic option for refractory glaucoma.

Observation:

• A patient with CREST syndrome developed bilateral retinal vasculitis eight days after undergoing mTS-CPC in one eye.
• The clinical presentation initially raised concern for sympathetic ophthalmia due to bilateral ocular inflammation.
• The patient's symptoms resolved following treatment with oral prednisone.

Findings:

• This report describes the first instance of CREST syndrome-associated retinal vasculitis potentially triggered by mTS-CPC.
• The timing suggests a possible inflammatory response secondary to the mTS-CPC procedure in a predisposed individual.
• The case highlights the importance of considering iatrogenic causes for ocular inflammation in patients with autoimmune conditions.

Implications:

• Ophthalmologists should be aware of the potential for mTS-CPC to precipitate or exacerbate autoimmune-related ocular inflammation, such as CREST vasculitis.
• This case underscores the need for careful patient selection and monitoring after mTS-CPC, particularly in those with connective tissue diseases.
• Further research may elucidate the mechanisms linking mTS-CPC-induced inflammation and autoimmune vasculitis in susceptible patients.