Autoimmune retinal microangiopathy
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Angela Corduneanu1, Natalia Corduneanu2, Alina Moscalciuc1
1Ophthalmology Department, "Timofei Moşneaga" Republican Clinical Hospital, Chişinău, Republic of Moldova.
Purpose:
To describe a patient with proliferative vascular retinopathy as an ocular complication of an autoimmune connective tissue disease.
Method:
Case report.
Results:
A 27-year-old female patient was referred for a regular eye examination, 5 months after the onset of dermatomyositis. On examination, visual acuity was 20/20 in both eyes. The anterior segment was normal. Funduscopy showed microhemorrhages and numerous retinal neovessels in both eyes. The established diagnosis was proliferative vascular retinopathy in dermatomyositis. The patient received treatment with multiple intravitreal anti-VEGF injections. Despite a good response to dermatomyositis treatment with methylprednisolone 4 mg per day and methotrexate 15 mg per week, the retinal neovascularisation reactivated within 3-4 months after anti-VEGF injections. Laser retinal photocoagulation has been performed, and the patient's follow-up continues.
Discussion:
Proliferative vascular retinopathy represents an exceedingly rare ocular manifestation of dermatomyositis. The marked bilateral retinal capillary nonperfusion and recurrent neovascularization observed in this patient are consistent with a severe ischemic microangiopathic process, potentially related to immune-mediated endothelial injury. Only isolated cases of proliferative retinopathy associated with overlap connective tissue disease have been reported, underscoring the unusual nature of this case.
Conclusion:
Proliferative vascular retinopathy may occur secondary to dermatomyositis. All clinicians must recognize this rare association to detect and treat it early.
