We aimed to describe a case of neovascular glaucoma (NVG) as a first presenting sign of catastrophic antiphospholipid syndrome (CAPS) with heart valve aseptic vegetations known as Libman-Sacks endocarditis. A 39-year-old man was referred for left eye decreased visual acuity and pain, upon examination left eye high intraocular pressure; rubeosis iridis of both eyes (BE); and prominent retinal ischemia. Clinical and fluorescein angiography findings established the diagnosis of left eye NVG with vaso-occlusive disease in BE. Magnetic resonance imaging of the head showed widespread ischemic lesions and hemorrhagic foci. The transesophageal echocardiogram showed 2 big mitral valve lesions consistent with the diagnosis of Libman-Sacks endocarditis. Laboratory and clinical diagnosis of CAPS and suspected SLE was confirmed, and treatment with anticoagulants and IV steroids was initiated. This case demonstrates that severe vaso-occlusive retinopathy with severe brain ischemia should raise the suspicion of systemic autoimmune pro-coagulative diseases with heart valve aseptic vegetations.
Case Rep Ophthalmol 2021;12:664–669

中文翻译：

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新生血管性青光眼是具有“灾难性”心脏瓣膜发现的灾难性抗磷脂综合征的表现征兆

我们的目的是将一例新生血管性青光眼 (NVG) 描述为灾难性抗磷脂综合征 (CAPS) 的第一个症状，并伴有称为 Libman-Sacks 心内膜炎的心脏瓣膜无菌性赘生物。一名 39 岁男性因左眼视力下降和疼痛被转诊，经检查左眼眼压高；双眼虹膜红肿（BE）；和突出的视网膜缺血。临床和荧光素血管造影结果确定了 BE 左眼 NVG 伴血管闭塞性疾病的诊断。头部磁共振成像显示广泛的缺血性病变和出血灶。经食道超声心动图显示 2 个大二尖瓣病变，符合 Libman-Sacks 心内膜炎的诊断。CAPS和疑似SLE的实验室和临床诊断得到证实，并开始使用抗凝剂和 IV 类固醇进行治疗。该病例表明，伴有严重脑缺血的严重血管闭塞性视网膜病变应引起对心脏瓣膜无菌性赘生物的全身性自身免疫性促凝疾病的怀疑。
Case Rep Ophthalmol 2021；12:664–669