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Case Reports
. 2022 Nov 10;13(3):834-841.
doi: 10.1159/000526543. eCollection 2022 Sep-Dec.

Retinal Pigment Epithelial Detachment Associated with Immunoglobulin A Nephropathy: A Case Report

Ayano Sakuma  1 , Tadahiko Ogata  1 , Makiko Wakuta  1 , Tomoko Orita  2 , Kazuhiro Kimura  1
Affiliations
Case Reports

Retinal Pigment Epithelial Detachment Associated with Immunoglobulin A Nephropathy: A Case Report

Ayano Sakuma et al. Case Rep Ophthalmol. .

Abstract

Uveitis and scleritis are eye diseases associated with immunoglobulin A (IgA) nephropathy, but reports on retinal pigment epithelial detachment (PED) in relation to IgA nephropathy are scarce. We have experienced a case of PED associated with IgA nephropathy that was improved by pulse steroid treatment. A 68-year-old woman underwent examination for visual loss in the right eye. Her corrected visual acuity was 20/20 on both sides, and serous PED was observed in both eyes. One month later, the PED improved in both eyes but recurred 3 months later. Results of blood examination raised suspicion of IgA nephropathy, and she was referred to a nephrologist. Two weeks later, the PED in both eyes worsened, and a retinal pigment epithelium (RPE) tear appeared in the right eye. A sub-Tenon's injection of triamcinolone acetonide was performed to address the PED, but it was not effective; thus, pulse steroid therapy was performed twice. The PED disappeared from both eyes, and the visual acuity in her left eye was maintained at 20/20, but it decreased to 20/200 in her right eye due to macular atrophy after the RPE tear. The PED had not recurred despite having no improvement in renal function. In conclusion, in IgA nephropathy, deposition of immune complexes on the RPE causes its inflammation, which may lead to PED. In cases of unexplained PED, the possibility of a systemic disease as the cause should be considered.

Keywords: IgA nephropathy; Pigment epithelial detachment; Pulse steroid therapy; Retinal pigment epithelium tear.

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Conflict of interest statement

The authors declare no conflict of interests.

Figures

Fig. 1.
Fig. 1.
Findings at first consultation. a Fundus photograph of the right eye. Drusen was found around the ear arcade, and a prominent lesion was seen in the macula. b Optical coherence tomography (OCT) image of the right eye. A dome-shaped raised pigment epithelial detachment (PED) was observed. c Fundus photograph of the left eye. Drusen was observed around the arcade. d OCT image of the left eye. A small PED was observed on the inferior of fovea. e Fluorescein angiography (FA) image of the right eye (late). f FA image of the left eye (early). g Indocyanine green angiography (IGA) image of the right eye (early). The fluorescence block, indicating PED, is recognized. h IGA image of the left eye (late).
Fig. 2.
Fig. 2.
Progress after first consultation (4.5 months after the first visit). a Fundus photograph of the right eye. Tear formation of the retinal pigment epithelium (RPE) is observed. b Optical coherence tomography image of the right eye. In the RPE tear, the RPE has rolled up.
Fig. 3.
Fig. 3.
Progress after pulse steroid therapy (1 year and 2 months after the first visit). a Fundus photograph of the right eye. The macula had extensive atrophic lesions. b Fundus photograph of the left eye. This is unclear because of steroid-induced cataract, but atrophic lesions are seen on the ear side. c Optical coherence tomography (OCT) image of the right eye. The ellipsoid zone in the macula has disappeared, and the elevated RPE has increased. d OCT image of the left eye.
Fig. 4.
Fig. 4.
Latest progress (5 years and 10 months after the first visit). a Fundus photograph of the right eye. b Fundus photograph of the left eye after cataract surgery. c Optical coherence tomography (OCT) image of the right eye. The height of the ridge is lower. d OCT image of the left eye.
See this image and copyright information in PMC

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