Bilateral macular sub‐retinal fluid and retinal pigment epithelial detachment associated with type 2 membrano‐proliferative glomerulonephritis

Abstract

Choroidal neovascularisation (CNV) and idiopathic central serous chorioretinopathy (ICSC) are recognised ocular complications related to type 2 membrano-proliferative glomerulonephritis. We report a 38-year-old white male who presented with a 10-day history of blurring of vision, micropsia and metamorphopsia. He had been diagnosed recently to have type 2 membrano-proliferative glomerulonephritis. On examination, there was bilateral retinal pigment epithelial (RPE) detachment with overlying subretinal fluid without any drusen. Fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) confirmed the diagnosis of atypical ICSC. Three months later, sub-retinal fluid and RPE detachment resolved and VA had recovered to 6/6. The case highlights the importance of ophthalmological assessment in these patients to recognise sight-threatening complications. Key words: glomerulonephritis, macula, retinal pigment epithelial detachment Type 2 membrano-proliferative glomerulonephritis (MPGN) is an early adulthood disease, which usually presents as proteinuria, haematuria and renal impairment.1 MPGN, also known as dense deposit disease, is characterised pathologically by electron dense deposits on the basement membranes in the glomeruli of the kidney and similar changes in Bruch's membrane are also seen.2 Duvall-Young, MacDonald and McKechnie 3 were the first to describe the association of retinal pigment epithelial (RPE) changes and this disease in 1989. They demonstrated that the electron microscopic appearance of these dense deposits in the glomerular capillary basement membrane and Bruch's membrane are similar. 3Choroidal neovascularisation and idiopathic central serous chorioretinopathy (ICSC) are recognised ocular complications related to the electron dense deposits in this disease. 4 We report a case that presented with bilateral pigment epithelial detachment (PED) with overlying subretinal fluid and describe fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) findings in this patient. CASE REPORTA 38-year-old white male presented with a 10-day history of blurring of vision, micropsia and metamorphopsia in both eyes. Past ocular history did not reveal any previous ocular problems. Four months earlier, he had been diagnosed with type 2 MPGN, which was confirmed on renal biopsy. He also had systemic hypertension, hyperlipidaemia, vitamin B12 deficiency and folate deficiency secondary to chronic renal failure.On examination distance visual acuity (VA) was 6/9 in the right eye and 6/12 in the left eye, which improved to 6/6 with pin hole. Near VA was N10 and N12 in the right and left eyes, respectively. Amsler grid testing showed central distortion. Anterior segment examination was normal in both eyes. There was no relative afferent papillary defect (RAPD). Fundus examination showed an elevated area overlying the macula in both eyes.

Antiretinal antibodies in central serous chorioretinopathy: prevalence and clinical implications

“…; Awan et al. ). It is unclear whether CSC in these patients is only caused by glucocorticoid treatment prescribed for these conditions or whether it is also influenced by the presence of inflammatory disease (Wang et al.…”

Multimodal imaging of retinal pigment epithelial detachments in patients with C3 glomerulopathy: case report and review of the literature

“…It helps to define exactly which layers of the retina are affected by the disease, and allows the diagnosis of any secondary complication (choroidal neovascularization, CNV or atrophy). In the literature, many structural alterations in outer retinal layers and RPE were reported in patients with C3 glomerulopathy: irregularities in RPE surface, lucent or tent-shaped RPE detachments or elevations, sub-RPE drusenoid deposits, areas of compression of the photoreceptor layer, missing inner segments/outer segments IS/OS and external limiting membrane ELM back-reflection [ 1 , 2 , 11 , 26 , 28 ]. A prototype high-speed ultrahigh optic coherence tomography (UHR-OCT) with an axial resolution of approximately 3 μm in tissue was realized in the left eye of a 29-year-old man, affected by drusen-like deposits in the context of C3 glomerulopathy.…”

Chronic Tubulointerstitial Nephritis Associated with Multiple Retinal Pigment Epithelial Detachment: Case Report

“…4,5 Tubulointerstitial nephritis (TINU) and uveitis syndrome are generally associated with anterior uveitis. In rare cases, TINU can be associated with posterior uveitis and pigment epithelium detachments.…”