Lupus retinopathy manifesting unilateral neovascular alterations: A case with 15 years of follow-up.

Purpose: To report a rare case of lupus retinopathy, characterized by unilateral neovascular alterations and asymmetrical clinical progression. Observations: A 32-year-old woman diagnosed with systemic lupus erythematosus (SLE) was referred to the ophthalmology department with decreased and blurred vision in the right eye. The patient was diagnosed with SLE at 31 years of age owing to cutaneous lupus, oral ulcers, and arthritis with a positive antinuclear antibody. Initial fundus assessment showed bilateral cotton wool spots predominantly in the right retina, and fluorescein angiography revealed nonperfusion areas exclusively in the right retina. Therefore, bilateral lupus retinopathy was diagnosed. Laboratory tests indicated the absence of concurrent antiphospholipid syndrome. The patient discontinued follow-up visits to the ophthalmology department for 1 year. Upon re-examination, a prominent neovascular membrane and vitreous hemorrhage were observed in the right eye, whereas cotton wool spots in the left eye resolved. The patient underwent lens-sparing pars plana vitrectomies two times. In the 15-year period after the vitrectomies, no recurrence of neovascular alterations in the right eye was noted. Conclusions and importance: Although lupus retinopathy generally presents with similar severity in both eyes, the patient in this study demonstrated unilateral neovascular alterations and asymmetrical clinical progression. These findings indicate the requirement for careful monitoring of patients with asymmetrical lupus retinopathy, even in those without antiphospholipid syndrome.