Sir,

Ankylosing spondylitis is a seronegative arthropathy which typically involves sacroiliac joints. We described a patient of ankylosing spondylitis with bilateral occlusive retinal vasculitis.

A 29-year-old man presented with 1 month history of decreased vision in both eyes. Visual acuity was 3/10 in the right eye and 10/10 in the left eye. There was 2+ vitreous cell in each eye. Fundus examination revealed branch retinal vein occlusion, sheathed vessels and retinal haemorrhages at the superior and inferior temporal region in both eyes with macular oedema in the right eye (Figure 1a, b). Fundus fluorescein angiography showed retinal vasculitis in both eyes (Figure 2a, b). The review of his medical history revealed that he had ankylosing spondylitis.

Figure 1
figure 1

(a) Fundus photograph showing sheathed vessels and (b) retinal haemorrhages in both eyes.

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Figure 2
figure 2

(a) Fluorescein angiogram showing retinal vasculitis and (b) hypofluorescence due to retinal haemorrhages in both eyes.

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Laboratory investigations including complete blood counting, prothrombine time and active thromboplastine time, protein C and S, antithrombine III, active protein C resistance, factor V leiden existence, anticardiolipin antibody M and G, homocystein, vitamin B12 and folic acite levels, ANA (antinuclear antibody), anti-double-stranded DNA (anti-Ds DNA) tests were normal. The patient had no oral afts and pathergy skin reaction was negative. HLA class I antigen testing revealed HLA-B27 positivity, but HLA-B5 negativity. Sacroiliac joint graphy showed periarticular sclerozis and irregular loss of the joint space. According to the clinical and laboratory examinations he did not have tuberculosis, sarcoidosis, or inflammatory bowel disease. Cardiovascular and neurological examination revealed no pathology. According to immunology and dermatology consultations, the diagnosis of ankylosing spondylitis had comeout right. Behçet's disease was not considered.

The patient was placed on a regimen of intravenous methylprednisolone (1 g/day) for 3 days because of the existing inflammatory findings. Additionally, both eyes received retrobulber methylprednisolone acetate injection. After 3 days, the treatment was continued with a maintenance dose of oral prednizolone (20 mg/day).

Retinal vein occlusion is associated in older ages with common systemic vascular disorders such as hypertension, arteriosclerosis, and diabetes mellitus.1 Coagulation deficiency, hyperviscosity syndromes, chronic leukemia, mitral valve prolapse, homocysteinemia, Behçet's disease, and systemic inflammatory diseases may also cause retinal vein occlusion in younger ages.1, 2, 3, 4 However, our case did not demonstrate any of them.

Ankylosing spondylitis is common in 20–40-year-old males and HLA-B27 antigen is present in about 96% of the patients. The joint involvement is asymmetric and periferic. Ocular involvement occurs in 20–30% of patients with ankylosing spondylitis. The ocular findings include recurrent, nongranulomatous iridocyclitis, which rarely affects vision.5 Posterior inflammatory manifestations such as severe vitritis, papillitis, and retinal vasculitis have been described in patients with ankylosing spondylitis.6

In summary, we report an unusual case of ankylosing spondylitis presenting with bilateral occlusive retinal vasculitis.