TRANSIENT MONOCULAR BLINDNESS AND ANTIPHOSPHOLIPID ANTIBODIES IN SYSTEMIC LUPUS-ERYTHEMATOSUS

Background and Objective: Among patients with systemic lupus erythemat osus (SLE), the presence of antiphospholipid antibodies (APA), notably the lupus anticoagulant, and anticardiolipin antibodies (aCL) charact erizes a subset of patients with a thrombotic tendency. During the reg ular follow-up care of patients with SLE, we noticed that many describ ed transient visual disturbances. Because a hypercoagulable state may cause transient monocular blindness (TMB), we determined the frequency of TMB and studied its relation to the presence of APA in patients wi th SLE. Methods: We asked 175 unselected patients with SLE whether the y had transient visual disturbances and reviewed their medical charts. All patients were examined with specific attention to the presence of livedo reticularis. Blood was examined for APA. Results: Visual distu rbances were recorded for 136 (78%) patients. According to predefined criteria, the symptoms were diagnosed as TMB for 10 (6%) patients and as visual disturbances associated with migraine for 18 (10%) patients. Five of the 10 patients with TMB had attacks in either eye. The 175 p atients with SLE accrued a maximum total of 6,349 patient years in the ir lifetime. From this, the incidence of TMB can be calculated to be a t least 158 per 100,000 per year. Lupus anticoagulant was detected in 3 of 10 patients with TMB and 41 of 165 patients without TMB (odds rat io, 1.3; 95% CI, 0.2 to 6.0). aCLs were found in 5 of 10 patients with TMB and 91 of 165 patients without TMB (odds ratio, 0.8; 95% CI, 0.2 to 3.7). Conclusions: The frequency of TMB among patients with SLE is at least 158 per 100,000 compared with the normal population (14 per 1 00,000 per year). However, among patients with SLE, no significant rel ation could be shown between TMB and the presence of APA or livedo ret icularis.