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Autoimmune optic neuropathy as the first manifestation of systemic lupus erythematosus109Figure 5: The papillary OCT revealing the loss of the nerve fiber layer in temporal and inferior quadrants, nine years after the onset ofthe diseaseand visual field changes suggested an ischemic opticneuropathy affecting both eyes within a few weeks,pointing to the diagnosis of an inflammatory vasculardisease.The optic neuritis secondary to SLE is a raremanifestation, present in approximately 1% of thesepatients, most of whom with some degree of systemicinvolvement by the disease (6,8,9) . The main findings inthese patients are the visual loss, the pain on ocularmovement and a neuropathy caused by an ischemicprocess as it was observed in the present case.There are some reports in literature of rare caseswith the vision loss as the first symptom noticed by theSLE patients. In these reports, at the time ofophthalmologic examination the patient already hadlaboratory abnormalities consistent with the diagnosisof the disease, (8-11) which differs from the case we reportedand makes it even more interesting because, in thispatient, the ocular changes preceded even the specificexams for SLE and the diagnostic criteria were only metabout 7 months after the first ocular manifestations.Autoimmune optic neuropathy can occur as amanifestation of a vascular connective tissue disease. Itresponds well to corticosteroid therapy and can becomesteroid dependent, unlike our patient who did not respondto massive doses in the treatment. Another difference isthe symptoms, where the autoimmune optic neuritisusually is not accompanied by orbital pain (12,13) .This case shows the value of the ocular complaintsin systemic diseases. And how the ophthalmologic examcan help the clinician elaborating a diagnosis.It is also very important for ophthalmologists andrheumatologists due to the fact that it calls the attentionto another diagnostic hypothesis in patients withnonspecific optic neuritis, even with inconclusivelaboratory tests. And maybe some ocular findings deserveto be included to the diagnostic criteria alreadyestablished for SLE.Rev Bras Oftalmol. 2012; 71 (2): 106-10
110Amigo MHL, Bárbara ECD, Ghirelli WREFERENCES1. Hillmann DB. Arthritis & musculoskeletal disorders. In: TierneyLM Jr, McPhee SJ, Papadakis MA, editors. Current medicaldiagnosis & treatment. 36th ed. Stamford: Prentice Hal; 1997.20:774-7.2. Mendes LE, Gonçalves JOR, Costa VP, Belfort Junior R.Alterações oculares no lúpus eritematoso sistêmico. Arq BrasOftalmol. 1998;61(6):713-6.3. Bigolin S, Oyamaguchi E, Claro C, Bryk Junior A, KomatsuMCG, Belotto E, Postella E. Achados oculares e fundoscópicosem pacientes com lúpus eritematoso sistêmico. Arq BrasOftalmol. 2000;63(5):383-6.4. Im CY, Kim SS, Kim HK. Bilateral optic neuritis as first manifestationof systemic lupus erythematosus. Korean JOphthalmol. 2001;16(1):52-8.5. Fernández Fernández FJ, Fernández Larrañaga JR, PérezFernández S, Rodríguez Ríos M, Mardomingo Varela P.Opticneuritis as first manifestation of systemic lupuserythemathosus]. An Med Interna. 2004;21(7):366.Spanish.6. Wong K, Ai E, Jones JV, Young D. Visual loss as the initialsymptom of systemic lupus erythematosus. Am J Ophthalmol.1981;92(2):238-44.7. Riedel P, Wall M, Grey A, Cannon T, Folberg R, Thompson HS.Autoimmune optic neuropathy. Arch Ophthalmol.1998;116(8):1121-4.8. Traboulsi EI, Manso AM, Aswad MI, Gharzuddin W, FrayhaRA. Homonymous hemianopia and systemic lupus erythematosus.J Clin Neuroophthalmol. 1985;5(1):63-6.9. Ahmadieh H, Roodpeyma S, Azarmina M, Soheilian M, SajjadiAH. Bilateral simultaneuous optic neuritis in childhood systemiclupus erythematosus. A case report. J Neuroophthalmol.1994;14(2):84-6.10. Sklar EM, Schatz NJ, Glaser JS, Post MJ, ten Hove M. MR ofvasculitis-induced optic neuropathy. AJNR Am J Neuroradiol.1996;17(1):121-8.11. Jabs DA, Miller NR, Newman SA, Johnson MA, Stevens MB.Optic neuropathy in systemic lupus erythematosus. ArchOphthalmol. 1986;104(4):564-8.12. Kupersmith MJ, Burd RM, Warren FA, Klingele TG, FrohmanLP, Mitnick H. Autoimmune optic neuropathy: evaluation andtreatment. J Neurol Neurosurg Psychiatry. 1988;51(11):1381-6. Erratum in J Neurol Neurosurg Psychiatry. 1989;52(5):692.13. Cardoso LMCD, Zacharias LC, Monteiro MLR. Neuropatiaóptica auto-imune: relato de caso. Arq Bras Oftalmol.2006;69(4):593-5.Corresponding author:Wagner GhirelliRua Maria Figueiredo,nº 283Phone: 55 – 11 - 3371-3324E-mail: wagnerghirelli@yahoo.com.brRev Bras Oftalmol. 2012; 71 (2): 106-10
Page 2 and 3: RevistaBrasileira deOftalmologiaPUB
Page 4 and 5: RevistaBrasileira deOftalmologia75I
Page 6 and 7: EDITORIAL77Ultrassonografia orbitá
Page 8 and 9: ARTIGO ORIGINAL79Influência da ane
Page 10 and 11: Influência da anestesia geral e bl
Page 12 and 13: Influência da anestesia geral e bl
Page 14 and 15: Eficácia do uso intraoperatório d
Page 17 and 18: 88Correa e Silva RS, Ávila MP, Pau
Page 19 and 20: 90Ambrósio Jr R; Borges JS; Costa-
Page 29 and 30: 100ARTIGO ORIGINALAvaliação do co
Page 31 and 32: 102Rached CR, Oliveira TC, Sousa CL
Page 36 and 37: Autoimmune optic neuropathy as the
Page 40 and 41: RELATO DE CASO111Úlcera de córnea
Page 42 and 43: Úlcera de córnea por Pseudomonas
Page 44 and 45: RELATO DE CASO115Relevância da bio
Page 46 and 47: Relevância da biomecânica da cór
Page 48 and 49: ARTIGO DE REVISÃO119Facoemulsifica
Page 50 and 51: Facoemulsificação versus extraç
Page 52 and 53: Facoemulsificação versus extraç
Page 54 and 55: ARTIGO DE REVISÃO125Avaliação da
Page 56 and 57: Avaliação da camada de fibras ner
Page 68 and 69: COMENTÁRIO SOBRE LIVRO OFTALMOLÓG
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