Plasmapheresis in the management of choroidal vasculitis associated with C-anca positive renal vasculitis.

PURPOSE: The purpose of this study was to report the use of plasmapheresis in the management of choroidal vasculitis associated with Wegener granulomatosis.

METHOD: Case report.

PATIENT: A 50-year-old woman with acute renal failure as a result of glomerulonephritis of the Wegener granulomatosis type presented with sudden visual loss. Visual acuities at presentation were counting fingers in the left eye and 6/24 in the right eye. Clinical examination showed significant choroidal ischemia with no evidence of vitritis or anterior segment inflammation. Fluorescein and indocyanine green angiography confirmed choroidal vasculitis.

RESULTS

The patient was treated with a course of seven plasmapheresis sessions, after which she was maintained on prednisolone and mycophenolate. One week after her presentation, vision improved to 6/6 bilaterally. The angiographic appearances resolved, and the patient was maintained on immunosuppression.

CONCLUSION

We believe that the prompt use of plasmapheresis prevented irreversible visual loss in this patient. This case illustrates the dramatic improvement in choroidal perfusion presumably resulting from the removal of a circulating immune factor.