Combined central retinal artery and vein occlusion; first manifestation of lupus in a pediatric patient.

Combined central retinal artery and vein occlusion is uncommon in adults and even more so in young people. The main origins are vasculitis and thromboembolic disorders. The prognosis is poor due to irreversible visual loss and the development of neovascular glaucoma (NVG). A 14 year-old male arrived at the clinic complaining of sudden and painless visual loss in the left eye. Best corrected visual acuity was light perception with clinical and fluoro-angiographic findings characteristic of combined central retinal artery and vein occlusion in his left eye. The findings in the systemic and laboratory studies led to a diagnosis of systemic lupus erythematosus (SLE) and antiphospholipid syndrome. The patient received treatment with steroids and oral anticoagulant. Seven days later, due to prolonged coagulation time, he presented with a vitreous haemorrhage. He was then treated with intravitreal ranibizumab in order to prevent NVG. Afterwards, vitrectomy and retinal endophotocoagulation were performed. To the best of our knowledge, this is the first presentation of a male, paediatric with SLE and combined occlusion to be published in the literature, and is also the first case treated with antiangiogenic agents that has not developed NVG at 12 months of follow-up.