Purpose: To describe the ocular and systemic manifestations associated with systemic lupus erythematosus (SLE) choroidopathy.
Methods: Three new cases of choroidopathy in patients with active SLE were described. Twentyfive published cases of lupus choroidopathy were summarized.
Results: There have been 28 cases of lupus choroidopathy (47 involved eyes) that have been reported in the English literature since 1968, including the three current cases. Only two of the patients were male. The choroidopathy was bilateral in 19 patients (68%). All 28 patients (100%) had active systemic vascular disease at the onset of their choroidopathy; 18 (64%) had nephropathy and 10 (36%) had central nervous system (CNS) lupus vasculitis. All but one of the patients had a known diagnosis of SLE at the onset of choroidopathy. 30 of the 47 involved eyes had presenting visual acuity of 20=40 or better; 14 eyes showed improvement in visual acuity with therapy. 23 patients (82%) had resolution of their choroidopathy when their systemic disease was brought under control. Despite treatment, 4 of the 28 patients (14%) died from complications of SLE.
Conclusions: Although less known than retinopathy, lupus choroidopathy may be more common than generally appreciated. It usually serves as a sensitive indicator of lupus activity. The presence of SLE choroidopathy is generally indicative of coexistent (although sometimes occult) nephropathy, CNS vasculitis, and other SLE visceral lesions. Immunomodulation of the systemic disease can lead to improvement and resolution of the systemic vasculitis as well as the choroidopathy.
Tan E , Cohen A , Fries J et al. The 1982 revised criterion for the classification of systemic lupus crythematosus . Arthritis Rheum1982; 25: 1271–1277 .
2.
Nguyen Q , Foster C.Systemic lupus erythematosus and the eye . Int Ophthalmol Clin1998; 38: 33–60 .
3.
Aronson A , Ordonez N , Diddie K , Ernest J.Immune-complex deposition in the eye in systemic lupus erythematosus . Arch Intern Med1979; 139: 1312–1313 .
4.
Matsuo T , Nakayama T , Koyama T , Matsuo N.Multifocal pigment epithelial damages with serous retinal detachment in systemic lupus erythematosus . Ophthalmologica1987; 195: 97–102 .
5.
Schwartz M , Roberts J.Membranous and vascular choroidopathy: two patterns of immune deposits in systemic lupus erythematosus . Clin Immunol Immunopathol1983; 29: 369–380 .
Gass J.A fluorescein angiographic study of macular dysfunction secondary to retinal vascular disease . Arch Ophthalmol1968; 80: 606–617 .
8.
Diddie K , Aronson A , Ernest J.Chorioretinopathy in a case of systemic lupus erythematosus . Trans Am Opthalmol Soc1977; 75: 122–131 .
9.
Kinyoun J , Kalina R.Visual loss from choroidal ischemia . Am J Ophthalmol1986; 101: 650–656 .
10.
Klinkhoff A , Beattie C , Chalmers A.Retinopathy in systemic lupus erythematosus . Arthritis Rheum1986; 29: 1152–1156 .
11.
Hannouche D , Korobelnik J , Cochereau I et al. Systemic lupus erythematosus with choroidopathy and serous retinal detachment . Int Ophthalmol1995; 19: 125–127 .
12.
Jabs D , Hanneken A , Schachat A , Fine S.Choroidopathy in systemic lupus erythematosus . Arch Ophthalmol1988; 106: 230–234 .
13.
Kaufman A , Niles J , Foster C.ANCA test in ophthalmic inflammatory disease . Int Ophthalmol Clin1994; 34: 215–227 .
14.
Foster C, Sainz de la Maza M. The Sclera 1-95-136 Springer-Verlag: New York, 1994.
15.
Merkel P , Polisson R , Chang Y , Skates S , Niles J.Prevalence of antineutrophil cytoplasmic antibodies in a large inception cohort of patients with connective tissue disease . Ann Int Med1997; 126: 866–873 .
16.
Benitez del Castillo J , Castillo A , Fernandez-Cruz A , Garcia-Sanchez J.Persistent choroidopathy in systemic lupus erythematosus . Doc Ophthalmol1994; 88: 175–178 .
17.
Carpenter M , O'Boyle J , Enzenauer R , Enzenauer R , Waterhouse W.Choroiditis in systemic lupus erythematosus . Am J Ophthalmol1994; 117: 535–536 .
18.
Goldstein M.Neurological manifestations of systemic lupus erythematosus: role of antiphospholipid antibodies . Clin Exp Rheumatol1993; 11: 373–379 .
19.
McLean B , Miller D , Thompson E.Oligoclonal banding of IgG in CSF, blood-brain barrier function, and MRI findings in patients with sarcoidosis, systemic lupus erythematosus, and Behçet's disease involving the nervous system . J Neurol Neurosurg Psychiatry1995; 58: 548–554 .
20.
Snyers B , Lambert M , Hardy J.Retinal and choroidal vaso-occlusive disease in systemic lupus erythematosus associated with antiphospholipid antibodies . Retina1990; 10: 255–260 .
21.
Eckstein M , Spalton D , Holder G.Visual loss from central serous retinopathy in systemic lupus erythematosus . Br J Ophthalmol1993; 77: 607–609 .
22.
Nasser S , Fields P , Calver D , Bresnihan B , Gibson T.Irreversible blindness in systemic lupus erythematosis . Br J Rheumatol1993; 32: 935–936 .
23.
El-Asrar A , Naddaf H , Mitwali A.Choroidopathy in a case of systemic lupus erythematosus . Lupus1995; 4: 496–497 .
24.
Cunningham E , Alfred P , Irvine A.Central serous chorioretinopathy in patients with systemic lupus erythematosus . Ophthalmology1996; 103: 2081–2090 .
