Choroidal involvement in patients with catastrophic anti-phospholipid syndrome: Two case reports.

PURPOSE: To describe choroidal involvement in catastrophic antiphospholipid syndrome (CAPS). METHODS: We report here two cases of bilateral CAPS choroidopathy in two female patients. RESULTS: Case report 1: A thirty-five-year-old female patient, with history of primary anti-phospholipid syndrome (APS), treated with anticoagulants, presented an acute renal failure following a salpingectomy. She complained of bilateral acute blurred vision. Ophthalmologic evaluation revealed visual acuity (VA) of 5/10, extensive serous retinal (SRD) detachment, areas of hypofluorescence on fluorescein angiography (FA), and non-perfusion areas in the choriocapillaris, on optical coherence tomography angiography (OCT-A), in both eyes. Considering the diagnosis of probable CAPS, the patient received intravenous pulse steroids, plasmapheresis, intravenous anticoagulation and haemodialysis, with favourable evolution. Case report 2: A thirty-three-year-old female patient, with history of systemic lupus erythematosus (SLE) and secondary APS, treated with corticosteroids, immunosuppressive agents and anti-coagulation, presented a myocardiac infarction. She complained of bilateral acute blurred vision. Ophthalmologic evaluation revealed VA of 1/10 in the RE and 6/10 in LE, bilateral extensive SRD, leakage points on FA and non-perfusion areas in the choriocapillaris on OCT-A. Criteria of probable CAPS were fulfilled. Treatment with intravenous pulse steroids, anticoagulation and reanimation modalities allowed VA improvement. Alveolar haemorrhage and cardiogenic shock led to fatal evolution. CONCLUSION: Our case reports highlight the importance of early diagnosis and ophthalmic evaluation in CAPS. Multidisciplinary approach and rapid initiation of effective treatment, based on corticosteroids, anticoagulation and plasmapheresis, allow better vital and visual prognosis.

Acute posterior multifocal placoid pigment epitheliopathy associated with serous retinal detachment: A case report.

We report the occurrence of serous retinal detachment (SRD) in acute posterior multifocal placoid pigment epitheliopathy (APMPPE). A 22-year-old man with no general or ophthalmological pathological history presented with an acute and bilateral decreased visual acuity. There was no notion of recent flu or recent vaccination. There were anterior chamber cells and vitreous cells. Fundus revealed white-yellowish lesions, scattered on posterior pole and periphery, associated with SRD in both eyes. Fluorescein Angiography showed early hypofluorescence followed by late hyperfuorescence. Optical coherence tomography (OCT) showed hyperreflective bands of the outer nuclear layer and interruption of the ellipsoid zone associated with bilateral SRD. Repeat OCT revealed a spontaneous and complete regression of SRD in both eyes, and improvement of visual acuity after one week of evolution without any treatment. Serous retinal detachment is an uncommon manifestation of APMPPE. It is more suggestive of Vogt-Koyanagi-Harada disease (VKH), although angiographic features are typically observed in APMPPE. Moreover, spontaneous decrease of SRD within a few days is more in favor of APMPPE.