How do you manage occlusive bilateral retinal vasculitis with isolated lupus anticoagulant positivity?

Although I consider myself an expert on retinal vasculitis, I would often solicit help from a physician with expertise in coagulation, especially if that expertise is related specifically to the lupus anticoagulant. A tremendous part of the treatment strategy depends on the location and severity of the occlusions. For example, occlusions in the peripheral retina might not markedly affect visual function and could possibly just be managed with observation or aspirin. I have had success merely by eliminating a co-factor in some instances, especially estrogen containing oral contraception. Assuming that there is no obvious co-factor, the disease is affecting visual function, and the lupus anticoagulant is strongly implicated by laboratory results, I think that the main options are anti-coagulation versus B cell depletion or both. I would make this decision based on disease severity, patient preference, and input from an expert on antiphospholipid antibodies.

I would take this very seriously and employ immune suppression and full anticoagulation with coumadin.

I have never seen this situation, thankfully.

If occlusive, treat with anticoagulation.