OSLI Retina

February 2021

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102 © Ophthalmic Surgery, Lasers & Imaging Retina ■ C A S E R E P O R T ■ Cilioretinal Artery Occlusion in Posterior Scleritis Secondary to Ankylosing Spondylitis David J. A. Plemel, MD, FRCSC; Mark E. Seamone, MD, FRCSC; David I.T. Sia, MBChB, FRANZCO; Leonard Smith, MD, FRCSC; Rizwan Somani, MD, FRCSC ABSTRACT: The authors describe the case of a 25-year-old male who presented with a cilioretinal artery occlusion secondary to posterior scleritis. The patient had a history of juvenile spondyloar- thritis that evolved into ankylosing spondylitis. Cilioretinal artery occlusion is a rare complication of posterior scleritis, having only been described once previously in the literature. This is the first reported case of a cilioretinal artery occlusion in posterior scleritis that was associated with an un- derlying systemic disease. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:102-106.] INTRODUCTION Posterior scleritis can present a diagnostic di- lemma, due to its heterogenous presenting signs and symptoms. 1 Clinicians must be familiar with both the manifestations of posterior scleritis as well as its associated conditions. 2 Herein we describe the case of a 25-year-old male who presented with count fingers vision due to a cilioretinal artery oc- clusion secondary to posterior scleritis. The patient had a diagnosis of, and was actively being treated for, ankylosing spondylitis. This is, to the best of our knowledge, the first documented case of a cilio- retinal artery occlusion in posterior scleritis where the patient had an underlying systemic autoim- mune disease. CASE REPORT A 25-year-old Inuit male from a remote North- ern Canadian community presented with a 3-day history of acute central vision loss in the right eye. He had a medical history significant for juvenile spondyloarthritis diagnosed at age 10. Before start- ing immunomodulatory therapy at that age, he was successfully treated for latent tuberculosis (TB). In adolescence, his disease evolved, and he was diagnosed with ankylosing spondylitis (AS). At presentation, his treatment involved adalimumab, methotrexate, and folic acid. His past ocular his- tory included two previous episodes of acute an- terior uveitis in the affected right eye, both having occurred in the previous 3 years. On examination, visual acuity (VA) was count fingers in the right eye and 20/20 in the left eye. There was no relative afferent pupillary defect. Confrontational field exam in the right eye showed an intact peripheral field with loss of central vi- sion. The anterior and posterior examination of the left eye was normal with no active signs of inflam- mation. In the right eye, the anterior chamber and vitreous were quiet. In the macula there was sig- nificant retinal thickening and edema correspond- ing to the distribution of the cilioretinal artery. A neurosensory detachment of the macula was also noted. Ocular coherence tomography (OCT) dem- onstrated inner retinal hyperreflectivity associated with an underlying subfoveal exudative retinal de- tachment. Fluorescein angiography showed hypo- fluorescence in the distribution of the cilioretinal artery. There were chorioretinal folds. B-scan ultra- From the Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada (DJAP, MES, DITS, RS); Stanton Ophthalmol- ogy Clinic, North West Territories Health and Social Services, Yellowknife, Canada (LS). Originally submitted August 15, 2020. Revision received November 18, 2020. Accepted for publication November 18, 2020. The authors report no relevant financial disclosures. Address correspondence to David J. A. Plemel, MD, Suite 400, 10924 107 Avenue, Edmonton, AB, T5R 5T8, Canada; email: dplemel@ualberta.ca. doi: 10.3928/23258160-20210201-07

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