Bilateral severe capillary non-perfusion in a case of systemic lupus erythematosus with simultaneous combined retinal vascular occlusion

A young girl who developed central nervous system (CNS) and bilateral retinal vasculitis within one month of being diagnosed with systemic lupus erythematosus was treated with three doses of intravenous methylprednisolone (IVMP) with five cycles of plasma exchange therapy. Within a few days, she deteriorated tremendously with a sudden, severe drop in vision in both eyes. She was diagnosed with simultaneous central retinal artery and vein occlusion (CRVAO) in the right eye and hemicentral artery and vein occlusion in the left eye. She had bilaterally significant areas of capillary closure with neovascularization elsewhere and at the disc seen on fundus fluorescein angiography and swept source optical coherence tomography angiography. We discuss the challenges in management with a review of the literature.