Familial exudative vitreoretinopathy (FEVR) is an autosomal dominant inherited disease with a penetrance of nearly 100% and is mostly found in Asia. The most important sign is a temporal avascular retina with pathologically changed vessels combined with a temporal dragging of the disk and a heterotopy of the macula. In contrast to retinopathy of prematurity, only full-term children without oxygen therapy are affected. Clinical severity is highly variable. A stage of an asymptomatic gene carrier with peripheral ischemia only visible on angiography up to a massive deterioration of vision because of a combined tractional and rhegmatogenous retinal detachment is possible. All stages with intra- or subretinal exudates require therapy. First-line therapy is the coagulation of the leaky vessels to reduce the exudation. In addition cryocoagulation is possible. Advanced stages with complex retinal detachments usually require a vitrectomy to prevent further loss of visual function.
A nonrandomized, prospective, interdisciplinary pilot study of 102 patients with noncompressive optic disc swelling with visual loss (ODSWVL) was performed in order to investigate etiologic and pathogenetic mechanisms. Forty-six patients suffered from underlying inflammatory disease. Seventeen patients suffered from highly probable cardiogenic embolization, 16 patients from multiple vascular risk factors. The remaining patients of the noninflammatory disease group suffered from leukemia, previously unknown or severely decompensated diabetes mellitus, acute arterial hypertension, different kinds of coagulopathies and others. Ninety-six of the 102 patients required medical treatment according to general medical standards. Inhomogeneity of the underlying disease processes explains the ineffectiveness of different monotherapies in previous studies. Interdisciplinary search for the underlying causes allows causative treatment. ODSWVL and anterior ischemic optic neuropathy in particular seem to be a common final pathway of various pathogenetic mechanisms due to different etiologies rather than a disease entity by itself.
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