Proliferative vascular retinopathy in polymyositis and dermatomyositis with scleroderma (overlap syndrome)

Polymyositis and dermatomyositis: ocular manifestations and potential sight-threatening complications

Dermatomyositis (DM) and polymyositis (PM) are idiopathic inflammatory myopathies characterized by progressive, symmetric, mainly proximal muscle weakness. DM is also characterized by cutaneous involvement. However, other clinical features, systemic involvement, histopathological findings, response to treatment, and prognosis, differ significantly. Although uncommon, ocular manifestations in DM and PM may potentially affect any structure within the eye. Notwithstanding being generally mild, ocular involvement in DM and PM may result in significant morbidity. Left untreated, significant retinal inflammation associated with hemorrhage and detachment may occur, leading to significant vision loss. This review aims to present an up-to-date overview for rheumatologists about the ocular involvement and potential complications of DM and PM and when to refer to the ophthalmologist to avoid sight-threatening complications.

ASYMPTOMATIC MULTIFOCAL PARACENTRAL ACUTE MIDDLE MACULOPATHY ASSOCIATED WITH JUVENILE DERMATOMYOSITIS: OPTICAL COHERENCE ANGIOGRAPHY FINDINGS

PURPOSE

To describe a unique presentation of multifocal paracentral acute middle maculopathy in a young patient with juvenile dermatomyositis including optical coherence tomography angiography findings.

METHODS

Retrospective single case report.

PATIENT

Seventeen-year-old male patient with a history of juvenile dermatomyositis presented for routine hydroxychloroquine screening.

RESULTS

Optical coherence tomography revealed undulations of the outer retinal layers and retinal thinning near the fovea in both eyes. Optical coherence tomography angiography revealed loss of flow void densities in the superficial and deep capillary plexi in both eyes. These findings were consistent with a diagnosis of paracentral acute middle maculopathy.

CONCLUSION

To the authors' knowledge, this is the first report of the optical coherence tomography angiography findings in paracentral acute middle maculopathy associated with juvenile dermatomyositis. The defects were located in the superficial and deep capillary plexi and likely due to the known occlusive retinopathy associated with juvenile dermatomyositis.

Sclerodermatomyositis, ocular manifestations

BACKGROUND

Sclerodermatomyositis is an overlap syndrome of myositis and scleroderma, with dermatological, muscular and joint involvement, but may also present with ocular manifestations.

CLINICAL CASE

A 57 year-old woman presented with ophthalmological manifestations, including scleral thinning 360°, and the presence of cells in the anterior and posterior chamber. Oriented physical examination and laboratory studies led to the diagnosis, with the need for systemic treatment.

CONCLUSION

Sclerodermatomyositis is a rare disease. Its diagnosis needs thorough clinical and laboratory studies, and its management should be multidisciplinary when inflammatory ocular manifestations may be present.

Prevalence of ocular manifestations in systemic sclerosis patients

INTRODUCTION

Systemic sclerosis (scleroderma, SSc) is a severe chronic connective tissue disease caused by immune system disorders and changes in the structure and functions of blood vessels, which consequently leads to enhanced tissue fibrosis. The aim of the study was to evaluate changes in the organ of vision in systemic sclerosis patients.

MATERIAL AND METHODS

Overall the study involved 27 patients with systemic sclerosis. The control group comprised 27 age- and gender-matched healthy individuals. All the study subjects underwent complete ophthalmological examination that in systemic sclerosis patients additionally involved fluorescein angiography.

RESULTS

OPHTHALMOLOGICAL EXAMINATION REVEALED HIGHER INCIDENCE OF THE FOLLOWING ABNORMALITIES IN THE STUDY GROUP, COMPARED TO THE CONTROL: symptoms of dry eye syndrome (19 eyes, p < 0.02), astigmatism(in 30 eyes, p < 0.01), posterior subcapsular cataract (10 eyes, p < 0.05), increased intraocular pressure (> 21 mm Hg were observed in 11 eyes, p < 0.002) and vascular abnormalities within fundus in fluorescein angiography (20 eyes).

CONCLUSIONS

In patients with systemic sclerosis numerous abnormalities within the vision of organ may be found. Regular ophthalmological examinations are essential among the mentioned group. The examination should be particularly focused on the presence of retinal vascular abnormalities.

Purtscher-like retinopathy associated with dermatomyositis

BACKGROUND

To report a rare case of bilateral Purtscher-like retinopathy in a Chinese female patient with dermatomyositis.

CASE PRESENTATION

An 18-year-old woman with lower extremity muscle weakness was admitted due to decreased vision of both eyes for two weeks. Ophthalmic examination revealed violaceous eruption on eyelids with swelling. Ocular fundus examination revealed multiple cotton wool spots and Purtscher flecken, and intra-retinal haemorrhages with pseudo-cherry red spot. The erythrocyte sedimentation rate, C-reactive protein, lactate dehydrogenase and creatine kinase was measured and found to be increased. A diagnosis of Purtscher-like retinopathy associated with dermatomyositis was made and the patient was treated with corticosteroids.

CONCLUSION

Although dermatomyositis is a rare cause of Purtscher-like retinopathy, it is important to keep in mind that systemic associations such as dermatomyositis should be ruled out in such patients.