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A 62-year-old African American
male had a long-standing history of chronic joint damage and tophi deposition
in his hands. He complained of metamorphopsia in the left eye and slowly
progressing blurred vision in both eyes.
These symptoms are associated with which of the following disease?
Gout is an inflammatory disorder
in which there is the deposition of uric acid in tissues. It results in the
inflammation of various joints, especially the joints of the hand, knees, foot,
etc. However, various other organs are also reported to be involved including
the eye. The number of previous case reports determined the association of
various eye diseases such as conjunctivitis and anterior uveitis with
inflammation. Multiple studies reported the deposition of gouty crystal in the
cornea, sclera, and iris. Other associations between gout and blurred disc
margins, elevated intraocular pressure, and possibly posterior uveitis had been
reported in a previous case report. However, direct urate crystal deposits were
not observed in the retina.
Herein the case of a patient with
macular crystals and advanced systemic gout had been reported.
To manage the risk of macular degeneration, and vascular occlusions among gout patients the anterior and posterior examination of dilated eyeball should be carried out carefully.
The patient had a long-standing
history of uncontrolled gout.
The best-corrected visual acuity of the patient was 20/30 in both eyes. Anterior examination except posterior and bilateral nuclear subcapsular cataracts was normal. No corneal or conjunctival pathology was observed. The left macula of the patient demonstrated subretinal, highly refractile lesions and geographic atrophy. The lesions were predominately distributed at the termination of retinal arterioles in the macula. Epithelial mottling can be seen in the fundus exam of the right eye.
The patient was given the Amsler
grid for the improvement of his central visual field; he was followed up in the
clinic. His visual acuity and retinal exam were found to be stable over the
last 12 months. He reported a slight worsening of metamorphopsia in the left
eye.
Previous studies had not reported association of retinal lesions with gout, described as an effector of the anterior segment causing uveitis, conjunctivitis and corneal deposits. Hyperlipidemia and cholesterol emboli were considered the most likely causes of these findings. But these conditions had been well controlled by statin medication previously. Also, he has no cardiac disease or carotid artery.
Retinal involvement in
hyperlipidemia presents at a much earlier age and is prominent in patients with
familial hyperlipidemia syndromes. In this patient, the age-related macular
degeneration (ARMD) was also considered. Moreover, the macular degeneration is
rare in African American descent. Additionally, at the time of presentation,
the level of uric acid was normal, i.e., 5.3 mg/dL. Uric acid levels can be
normal at the time of an attack of gout as documented by previous studies,
therefore serum uric acid levels cannot help predict chronicity of the macular
lesions.
BMC Ophthalmol. 2018 Jan 19;18(1):11.
Retinal complications of gout: a case report and review of the literature
Ying Jiang et al.
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