Optical Coherence Tomography-Based Diagnosis and Monitoring of Systemic Lupus Erythematosus-Associated Choroidopathy

A 55-year-old female presented with bilateral lower limb swelling and facial swelling along with a decreased frequency of micturition. Baseline investigations revealed an elevated serum creatinine and blood urea nitrogen. Subsequent investigations revealed a positive antinuclear antibodies (ANA) +++ (titer 1:10,000, serum immunofluorescence method) and positive anti-double-stranded DNA (dsDNA) testing. A detailed ophthalmic evaluation was performed. Her visual acuity was 6/36 improving to 6/18 in either eye. The near vision was found to be N36 without any further improvement. A dilated fundus examination revealed multiple yellowish lesions throughout the posterior pole consistent with pockets of subretinal fluid in the right eye. A swept-source optical coherence tomography (OCT) was performed that revealed the presence of fluid in both the intraretinal and subretinal spaces. A bacillary layer detachment, with the accumulation of fluid in the intraretinal space, was noted. Similar fundus findings were seen in the left eye. A decision was made to employ plasmapheresis (PLEX) along with her routine thrice-weekly hemodialysis. Additionally, the systemic steroids were continued. At her third follow-up (day 22), her vision had improved to 6/9 unaided bilaterally and to N6 with the appropriate correction. There was a near-complete regression of the exudative retinal detachments bilaterally with pigmentary changes. The OCT scans revealed significant regression of the serous retinal and retinal pigment epithelium (RPE) detachments with a thin rim of residual subretinal fluid. Fundus examination and OCT studies established the diagnosis of systemic lupus erythematosus (SLE) choroidopathy and guided its further management with systemic immunosuppression, hemodialysis and plasmapheresis. There was a rapid resolution of the retinal and choroidal findings with visual recovery over the next month.