Bilateral Vitreous Hemorrhage in a Young Man with Pustular Psoriasis

A 25-year-old man consulted us with a severe exacerbation of pustular psoriasis for 10 days (Figure 1). The patient had pustular psoriasis for the last 12 years. During his hospital stay, he suffered sudden painless and profound loss of vision in both eyes. Subsequently, he was referred to an ophthalmologist. Slit lamp examination of both eyes revealed the presence of a clot in anterior chamber with neovascularization of the iris and the fibrovascular membrane covering the pupil and iris bombe formation nasally and inferiorly (Figure 2a). B-scan ultrasonography showed bilateral vitreous hemorrhage with normal optic nerve head in the right eye and an optic nerve cyst in the left eye (Figure 3). His erythrocyte sedimentation rate was 32.0 mm/hour, while blood and urine screening tests along with review of other systems were found to be normal. The fundi were not visualized due to dense hemorrhage. There was no history of trauma, recent ocular surgery, diabetes, hypertension, hematologic abnormalities, and drug intake known to cause vitreous hemorrhage. Topical medication (eye drop atropine 1%, timolol 0.5%, moxifloxacin and dexamethasone combination) and oral prednisolone (60 mg per day for 2 weeks) were prescribed but were later withdrawn in view of no response and worsening of skin condition. In the past, he had received various treatments, including phototherapy, acitretin, methotrexate, apremilast, cyclosporine, and mycophenolate mofetil; however, his condition was recalcitrant.