Unilateral macular drusen in a young female.

Case

A 27-year-old female with a history of systemic lupus erythematosus (SLE) was referred for evaluation of unilateral macular drusen. Family history of familial drusen was negative. On examination, visual acuity was 20/25 in the right eye (OD) and 20/20 in the left eye (OS). Funduscopy OD revealed numerous (>80) yellowish temporal perifoveal lesions (A). Funduscopy OS was normal (B).

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Enhanced depth imaging optical coherence tomography (EDI OCT)

Fluorescein angiography

Bevacizumab intravitreal injection.

Illustration – [Fig. 1].

Fig. 1

Findings

EDI OCT OD showed drusen-like deposits (DLDs) located between the retinal pigment epithelium and Bruch membrane, with the largest DLD measuring 232 μm in base and 89 μm in elevation (C). Macula OS was intact by EDI OCT (D). Further systemic work-up revealed no evidence of glomerulonephritis.

Diagnosis:

Drusen Like Deposits in SLE.

Correct Answer:

B.

Discussion

Ocular involvement in SLE can occur in up to 30% of patients.[1] Asymptomatic choroidal alteration and DLDs in patients with SLE glomerulonephritis were first described in 2011 by Baglio et al. using indocyanine green angiography.[2] Later in 2017, Invernizzi et al. documented presence of DLDs, with or without glomerulonephritis, however, they found that patients with glomerulonephritis demonstrated more DLDs per eye, larger DLDs, and DLDs involvement of >3 quadrants (all P < 0.03).[3] We advise patients with SLE to have a thorough dilated funduscopic examination. A screening EDI OCT should be considered in patients with SLE.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.