Idiopathic retinal vasculitis, arteriolar macroaneurysms and neuroretinitis: clinical course and treatment

Abstract

BackgroundThe purpose of the study is to describe the clinical course and treatment of idiopathic retinitis, vasculitis, aneurysms and neuroretinitis. The study utilized non-randomized, retrospective and interventional case series. The eight eyes of six patients were analysed. Testing included wide fluorescein angiography, indocyanine green angiography and systemic evaluation. Treatment involved observation, panretinal laser photocoagulation (PRP) for peripheral retinal ischemia, grid laser for macular oedema and focal laser on the macroaneurysms. The main outcome measures were initial visual acuity (VA), initial stage at diagnosis, clinical course, surgical intervention, final VA, final stage and complications of disease.ResultsFive out of eight eyes with retinal ischemia in more than two quadrants that were treated with PRP and grid laser for macular oedema maintained excellent VA and demonstrated no progression of retinal ischemia during follow-up. The two eyes which exhibited retinal ischemia in less than two quadrants and macular oedema were treated with grid laser and focal laser on the macroaneurysms, but did not undergo PRP. VA improved by two lines of the Snellen chart, and there was no progression of retinal ischemia during the 3 and 4 years of follow-up. One eye with neither retinal ischemia nor macular oedema was not treated, and the clinical picture remained stable during the follow-up.ConclusionEarly PRP may be considered in the presence of angiographic evidence of peripheral retinal non-perfusion. However, treatment could be withheld until the patient develops retinal ischemia in more than two quadrants.

Clinical Outcome of Retinal Vasculitis and Predictors for Prognosis of Ischemic Retinal Vasculitis

“…This is similar to a study on IRVAN cases which suggested using laser photocoagulation in eyes with retinal ischaemia even before NV is formed when there is more than two quadrants affected with capillary non-perfusion. 20 In our cohort, the use of corticosteroids was associated with a reduced risk of vision loss, including eyes with IRV and non-IRV. The use of corticosteroids and other antiinflammatory medications in managing vasculitis and some of its associated complications, such as CME, contributes to their role in preventing vision loss 19 .…”

A rare case of idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) syndrome

“…3 Favorable results have been noted with use of Ranibizumab. 6 Monoclonal antibodies such as Infliximab have been tried in treatment of IRVAN.…”

“…7 Duration of disease is variable and may take many months to years to manifest. 3 In our case presentation was acute and bilateral which prompted early initiation of treatment. Macular edema and exudates contributed to vision loss.…”

“…Medical management includes use of steroids to control the inflammation and works in early stage of disease. 3 Pan retinal photocoagulation (PRP) been suggested as the treatment of choice for IRVAN in the presence of widespread retinal ischemia so as to prevent the development of ocular neovascularization and vitreous hemorrhage.…”

“…However, if left untreated it may lead to severe bilateral visual loss. 2,3 Over the years, many therapeutic regimens have been evaluated. Medical management includes use of steroids to control the inflammation and works in early stage of disease.…”