Comprehensive overview of IRVAN syndrome: a structured review of Case Reports and Case Series

Abstract

Idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome is a rare spectrum of retinal vasculitis, aneurysms, and neuroretinitis affecting young individuals in their third decade. Most of our current knowledge is based on case reports, case series, and a handful of collaborative studies. There is much diversity in treatment approaches and outcomes in the reported literature. We have aggregated published case reports and case series into quantitative and narrative synthesis to draw evidence-based conclusions toward clinical features, atypical and rare findings, systemic associations, disease course, and treatment outcomes. The analysis suggested the disease mostly affects young individuals with a female predilection. Anterior chamber and vitreous inflammation are common than previously believed. The most prevalent pattern of retinal vasculitis in IRVAN eyes is mixed vasculitis, followed by arteritis and phlebitis. Most eyes at the time of presentation have capillary nonperfusion and require treatment. Most eyes retain good visual acuity; however, treatment is required to maintain visual function. Intravitreal antivascular endothelial growth factors administered as an adjunct to retinal laser photocoagulation are more likely to improve visual outcomes. Besides, we have discussed the different hypotheses on the etiopathogenesis of the disease and stronger evidence suggests an inflammatory origin of the disease.

Aflibercept for the Treatment of Macular Edema Secondary to Idiopathic Retinal Vasculitis, Aneurysms, and Neuroretinitis Syndrome

“…The pathogenesis of IRVAN is unclear. However, it is widely accepted that is a consequence of intraocular inflammation caused by the presence of mild intraocular inflammation, vasculitis, and the formation of epiretinal membranes [3]. Some authors have proposed that IRVAN is associated with a hypersensitivity reaction to tubercular antigens, indicating a link between IRVAN and systemic disease [4].…”