Coexistence of bilateral multifocal retinal pigment epithelial detachment and ankylosing spondylitis

Introduction: Bilateral multifocal retinal pigment epithelium (RPE) detachment is a very rare and serious ocular condition associated with age-related macular degeneration, central serous chorioretinopathy and systemic corticosteroid therapy. RPE detachment has not been yet reported in patients with ankylosing spondylitis (AS), which is a chronic systemic inflammatory disease commonly associated with acute anterior uveitis. In this report, we present an unusual case of bilateral multifocal RPE detachment as the only ocular manifestation in a patient with AS. Case description: A 34-year-old male patient with human leukocyte antigen-B27 positive AS was evaluated for possible ocular involvement. On posterior segment evaluation, there were several well-circumscribed light yellow, whitish lesions scattered throughout the posterior pole of both fundi. Fluorescein angiography demonstrated multiple well-defined areas of hyperfluorescence at the macula, corresponding to the localised collections of sub-RPE fluid. These findings were confirmed by spectral domain optical coherence tomography as bilateral multifocal RPE detachment. The patient is currently on follow-up for 8 months without any change in number or extent of RPE detachments. Discussion: This is the first case of AS associated with bilateral multifocal RPE detachment without any anterior segment involvement. This association could be a random coexistence, thus, further clinical studies are needed to reveal the casual relationship between AS and RPE.