Case Report: Localized retinal ischemia revealing an antiphospholipids syndrome: A case report and review of the literature

Abstract

Introduction Antiphospholipids syndrome is a rare autoimmune whose Clinical manifestations are very wide and different. Vaso-occlusive manifestations are the most frequent ones. Vessels of all organs can be involved. Ocular involvement is among the rarest. We report a case of retinal arterial thrombosis in the context of APS. Case report A 46-year-old patient with no previous medical history was admitted to the ophthalmology department for visual field amputation of the right eye without other associated signs. On the fundus, the left side was without abnormality and the right side was the site of a mixed arterial and superior temporal venous occlusion. Retinal angiography revealed a retinal focus in the superior temporal region with mixed occlusion of arterial and venous branches with ischemia of the superior temporal quadrant on the right and a retinal focus in the superficial inferior temporal region without occlusion on the left. Optical coherence tomography revealed ischemia of the superficial layers with alteration of the macular microvascularization in the right superior temporal quadrant. Immunological work-up showed antinuclear antibodies to be positive at 160 and anti-bgp1 positive with an IgG level of 118 IgM higher than 118 IgA at 101. The patient was put on effective anticoagulation with good clinical evolution. Conclusion Ocular involvement is rare in APS and associated with poor prognosis, it seems to be difficult to diagnose but also to manage. Larger studies are required to establish guidelines on how and when to screen asymptomatic APS patients for ocular damage, but also on how to prevent and treat it.