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Ophthalmic Images
January 10, 2019

Association of Ultrawide-Field Findings in Proliferative Retinopathy With Systemic Lupus Erythematosus

Author Affiliations
  • 1Wilmer Eye Institute, Retina Division, Johns Hopkins School of Medicine, Baltimore, Maryland
JAMA Ophthalmol. 2019;137(1):e183861. doi:10.1001/jamaophthalmol.2018.3861

An African American patient in their 30s with a history of systemic lupus erythematosus presented for a routine examination. The patient had normal vision and was asymptomatic. Extensive retinal neovascularization was seen on fundus examination (Figure, A). Ultrawide-field fluorescein angiography demonstrated diffuse peripheral vascular nonperfusion and leakage from the sea-fan retinal neovascularization (Figure, B), mimicking sickle cell retinopathy, which was subsequently ruled out, as was type 1 and 2 diabetes. Peripheral sea-fan retinal neovascularization is a rare reported manifestation of systemic lupus erythematosus retinopathy. The pathophysiologic characteristics of the retinal vasoocclusion is unknown, but are thought to be immune complex mediated or thrombotic.