Acute Frosted Retinal Periphlebitis

Frosted branch angiitis: a review

“…The typical onset of FBA after a multifactorial prodromal illness has led to the suggestion of a hypersensitivity reaction to various infective agents, 23 which may initiate FBA via a common pathway, possibly of immune-complex deposition. 13,38 This would support the use of systemic corticosteroids for those with substantial visual loss. However, the visual results with or without systemic steroid treatment thus far provide no clear guidance on treatment.…”

“…In summary, Frosted branch angiitis in typical form, unassociated with preexisting intraocular inflammation, is likely to be a primary immunological process in response to a number of provoking antigens. As discussed by Kleiner,13,68 an apparently different form exists, which is secondary to concurrent inflammation, most commonly in association with CMV retinitis. [51][52][53][54][55][56][57][58] Kleiner classifies the form seen in association with intraocular lymphoma or leukaemia differently, which Eye may mimic FBA but is probably an infiltrative process.…”

“…The phenomenon is rare and probably a new entity, only 57 cases having been recorded in the world literature ( Table 1). The great majority (75%) of patients are Japanese; indeed, it was not until 1988 13 that any patient outside Japan was reported. A total of 9 cases have subsequently been reported from the USA 13,25,27,32,44 and single cases from Turkey, 37 Korea, 40 India, 41 and Spain.…”

“…Macular scarring has severely limited vision in 3 patients. 13,25,37 Complications include retinal vein 13,49 or artery occlusion, 24 macular epiretinal membrane formation, 38 diffuse retinal fibrosis, 37 retinal tear formation, 13 vitreous haemorrhage, 50 optic disc atrophy 1 and peripheral atrophic retinal lesions. 1,9,16,30,37 The final visual acuity has been 6/60 or worse in 10% of affected eyes thus far reported (cases 1,14,34,42,46,48,52,55,56, Table 1), nine of which received systemic steroid treatment.…”

“…A presumed viral illness has preceded the onset in 33% of cases including our own. [2][3][4]5,7,13,17,19,22,23,25,27,29,31,35,39,41,42 No consistent aetiological agent has been identified, but positive serology results have been reported for: herpes simplex virus (HSV), 11,13,26,34,35,41 varicella zoster virus (VZV), 2,5,11,13,21 tuberculoprotein, 1,5,34 antistreptolysin O, 4,13,39 Epstein-Barr virus, 25 CMV, 34 Coxsackie virus A10, 31 adenovirus, 34 measles 34 and rubella. 41 The cases listed in Table 1 and referred to above appear, with limited variation, to adhere to Ito's original description of a primary idiopathic FBA.…”