Plasma exchange and rituximab in the management of acute occlusive retinal vasculopathy secondary to systemic lupus erythematosus

Ocul Immunol Inflamm. 2011 Oct;19(5):379-81. doi: 10.3109/09273948.2011.603069.

Abstract

Purpose: To report a case of acute occlusive retinal vasculopathy secondary to systemic lupus erythematosus (SLE) successfully treated with plasma exchange and rituximab

Methods: Case report.

Results: A 25-year-old female presenting acutely with lupus retinal vasculitis was treated urgently with plasma exchange after failure to respond to intravenous methylprednisolone. Following this, fluorescein angiography demonstrated reperfusion of occluded arterioles. Visual acuity improved from 6/60 to 6/6 bilaterally. Remission was maintained following rituximab (Rituxan) in combination with mycophenolatemofetil and oral prednisolone.

Conclusions: Early treatment with plasma exchange achieved reperfusion of the occluded microvascular circulation with correspondingly good visual recovery and should be considered when patients present with corticosteroid refractory retinal vasculitis associated with SLE.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Adult
  • Antibodies, Monoclonal, Murine-Derived / therapeutic use*
  • Female
  • Fluorescein Angiography
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Lupus Vasculitis, Central Nervous System / complications*
  • Lupus Vasculitis, Central Nervous System / therapy
  • Methylprednisolone / therapeutic use
  • Mycophenolic Acid / analogs & derivatives
  • Mycophenolic Acid / therapeutic use
  • Neuroprotective Agents / therapeutic use
  • Plasma Exchange*
  • Prednisolone / therapeutic use
  • Retinal Artery Occlusion / drug therapy
  • Retinal Artery Occlusion / etiology
  • Retinal Artery Occlusion / therapy*
  • Retinal Vasculitis / therapy
  • Rituximab
  • Treatment Outcome
  • Visual Acuity / drug effects

Substances

  • Antibodies, Monoclonal, Murine-Derived
  • Immunosuppressive Agents
  • Neuroprotective Agents
  • Rituximab
  • Prednisolone
  • Mycophenolic Acid
  • Methylprednisolone