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Davis JL. Defining Retinal Vasculitis. Am J Ophthalmol 2024; 267:84-89. [PMID: 38925285 DOI: 10.1016/j.ajo.2024.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE To assess the validity of retinal vasculitis as the preferred diagnostic term for multiple conditions. DESIGN Perspective. METHODS This Perspective is based on expert opinion and review of literature focused on the current nosology and pathology of retinal vasculitis. Interpretation of the subset of intraocular inflammation named "retinal vasculitis" based on fundamental knowledge of the blood-retinal barrier, the neurovascular unit, and pathological and functional responses to a variety of stimuli is provided. Correlation with multimodal imaging and known mechanisms of immunologically mediated disease are discussed. RESULTS A search of Medline in early 2024 for the phrase "retinal vasculitis" resulted in 2041 citations encompassing immunologic, genetic, neoplastic, infectious, drug-related, and ischemia-related disorders. Classification schemes and angiographic grading systems are descriptive and do not address pathologic mechanisms adequately, in part due to lack of histologic confirmation. Although optical coherence tomography (OCT) angiography holds promise for better imaging of retinal vascular changes, it does not reveal the key feature of leakage and only partially improves understanding of pathophysiology. Diagnosing catastrophic retinal vascular occlusion after intravitreal injections as a retinal vasculitis is the most recent example of speculative application of the term to complex and rare disorders. CONCLUSIONS Retinal vasculitis is a diagnostic term that is over-used and imprecise. Revised nosology should limit the term to primary inflammation of the retinal vasculature itself that results in opening of the blood-retinal barrier with or without retinal vascular occlusions. Pending new histologic or mechanistic evidence, the provisional term of "retinal vascular inflammation" or "retinal vasculopathy" should be used for leakage or occlusion occurring in the context of intraocular inflammation.
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Affiliation(s)
- Janet L Davis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
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Saifaldein AA, AlBloushi AF, Altariqi SM, Aljarallah S, Abu El-Asrar AM. Occlusive Retinal Vasculitis in Patients with Multiple Sclerosis. Ocul Immunol Inflamm 2023; 31:1750-1757. [PMID: 35914306 DOI: 10.1080/09273948.2022.2103717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/14/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE To investigate the frequency, clinical findings and outcomes of occlusive retinal vasculitis in patients with multiple sclerosis (MS). METHODS A retrospective case series. RESULTS During the period between January 2000 and December 2021, we identified 24 patients who were diagnosed to have uveitis associated with MS. Among them, four (16.6%) patients presented with bilateral occlusive retinal vasculitis who were diagnosed to have MS prior to presentation. All patients were treated successfully with a combination of systemic corticosteroids combined with mycophenolate mofetil. In addition, scatter laser photocoagulation was applied to the ischemic retina in all eyes. CONCLUSIONS Early recognition and prompt treatment with systemic immunosuppressive agents and scatter laser photocoagulation prevent complications and improve outcomes in MS patients with occlusive retinal vasculitis.
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Affiliation(s)
- Amjad Ameen Saifaldein
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman F AlBloushi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sulaiman M Altariqi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Salman Aljarallah
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed M Abu El-Asrar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Triggianese P, D'Antonio A, Nesi C, Kroegler B, Di Marino M, Conigliaro P, Modica S, Greco E, Nucci C, Bergamini A, Chimenti MS, Cesareo M. Subclinical microvascular changes in ANCA-vasculitides: the role of optical coherence tomography angiography and nailfold capillaroscopy in the detection of disease-related damage. Orphanet J Rare Dis 2023; 18:184. [PMID: 37430363 DOI: 10.1186/s13023-023-02782-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/18/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Both cardiovascular and complement-mediated disorders might lead to microvascular damages in anti-neutrophil cytoplasm autoantibodies (ANCA)-associated vasculitides (AAV). We aimed at investigating, for the first time, subclinical microvascular abnormalities with non-invasive techniques in AAV patients by analyzing both retinal and nailfold capillary changes. Retinal plexi were investigated using optical coherence tomography angiography (OCT-A), while nailfold capillary changes by video-capillaroscopy (NVC). Potential correlations between microvessels' abnormalities and disease damage were also explored. METHODS An observational study was conducted on consecutive patients who met the inclusion criteria of defined diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA), granulomatosis with polyangiitis (GPA), and microscopic polyangiitis (MPA), age ≥ 18 ≤ 75 yrs, and no ophthalmological disorders. Disease activity was assessed by Birmingham Vasculitis Activity Score (BVAS), damage by Vasculitis Damage Index (VDI), and poorer prognosis by the Five Factor Score (FFS). Quantitative analysis of vessel density (VD) was performed by OCT-A in both superficial and deep capillary plexi. Figures and detailed analysis from NVC were performed for all subjects in the study. RESULTS Included AAV patients (n = 23) were compared with 20 age/sex-matched healthy controls (HC). Retinal VD in superficial whole and parafoveal plexi resulted significantly decreased in AAV compared to HC (P = 0.02 and P = 0.01, respectively). Furthermore, deep whole and parafoveal vessel density was strongly reduced in AAV than HC (P ≤ 0.0001 for both). In AAV patients, significant inverse correlations occurred between VDI and OCTA-VD in both superficial (parafoveal, P = 0.03) and deep plexi (whole, P = 0.003, and parafoveal P = 0.02). Non-specific NVC pattern abnormalities occurred in 82% of AAV patients with a similar prevalence (75%) in HC. In AAV, common abnormalities were edema and tortuosity in a comparable distribution with HC. Correlations between NVC changes and OCT-A abnormalities have not been described. CONCLUSION Subclinical microvascular retinal changes occur in patients with AAV and correlate with the disease-related damage. In this context, the OCT-A can represent a useful tool in the early detection of vascular damage. AAV patients present microvascular abnormalities at NVC, whose clinical relevance requires further studies.
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Affiliation(s)
- P Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, 00133, Italy.
| | - A D'Antonio
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, 00133, Italy
| | - C Nesi
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, 00133, Italy
| | - B Kroegler
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, 00133, Italy
| | - M Di Marino
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, 00133, Italy
| | - P Conigliaro
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, 00133, Italy
| | - S Modica
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, 00133, Italy
| | - E Greco
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, 00133, Italy
| | - C Nucci
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, 00133, Italy
| | - A Bergamini
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, 00133, Italy
| | - M S Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, 00133, Italy
| | - M Cesareo
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, 00133, Italy
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Martinez-Velazquez L, Zhou P, López-Font FJ, Hoyek S, Feldman CH, Amato AA, Sobrin L, Patel NA. Retinal Vasculitis in a Patient With Isaacs Syndrome and Inclusion Body Myositis. JOURNAL OF VITREORETINAL DISEASES 2023; 7:165-170. [PMID: 37006658 PMCID: PMC10037760 DOI: 10.1177/24741264221133368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To report a case of bilateral occlusive retinal vasculitis in a patient with autoimmunity. Methods A case was analyzed and a literature review performed. Results A 55-year-old woman with autoimmune diagnoses of Isaacs syndrome and inclusion body myositis (IBM) reported decreased vision for 3 months. A fundus examination showed peripheral intraretinal hemorrhages in the right eye and an inferotemporal subhyaloid hemorrhage with adjacent intraretinal hemorrhages and preretinal fibrosis in the left eye. Fluorescein angiography showed temporal peripheral leakage and capillary dropout in both eyes, consistent with occlusive vasculitis. Scatter laser treatment to peripheral areas of retinal nonperfusion was followed by an intravitreal bevacizumab injection. Four months later, vision had stabilized at 20/15 in both eyes and the peripheral leakage had resolved. Conclusions This patient developed retinal vasculitis associated with the rare autoimmune neuromuscular disorders of Isaacs syndrome and IBM. An extensive workup showed the most plausible mechanism for the vasculitis was autoimmunity with a history of previously elevated antibodies levels associated with the antiphospholipid syndrome.
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Affiliation(s)
- Luis Martinez-Velazquez
- Department of Ophthalmology,
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Paul Zhou
- Department of Ophthalmology,
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | | | - Sandra Hoyek
- Department of Ophthalmology,
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Candace H. Feldman
- Division of Rheumatology, Immunology,
and Immunity, Department of Medicine, Harvard Medical School and Brigham and Women's
Hospital, Boston, MA, USA
| | - Anthony A. Amato
- Department of Neurology, Harvard
Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Lucia Sobrin
- Department of Ophthalmology,
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Nimesh A. Patel
- Department of Ophthalmology,
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
- Department of Ophthalmology, Bascom
Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL,
USA
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Rivera PA, Gupta A, Kombo N. Treatment of non-infectious retinal vasculitis. Ther Adv Ophthalmol 2023; 15:25158414231152761. [PMID: 37077655 PMCID: PMC10107051 DOI: 10.1177/25158414231152761] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/05/2023] [Indexed: 02/16/2023] Open
Abstract
Retinal vasculitis (RV) refers to an entity in which the retinal vasculature is inflamed, frequently with indications of inflammation elsewhere in the eye. Non-infectious RV can be idiopathic or associated with systemic disease, ocular conditions, and malignancy. It can also be classified based on the vessel affected: artery, vein, or both. Due to the lack of strong evidence-based treatment trials and algorithms for RV, physicians must often rely on their experience, which creates great variability in treating this entity. This article provides an overview of various treatment modalities used in the management of non-infectious RV, with a focus on immunomodulatory therapies. We outline a potential stepwise approach of starting with steroids to control the acute inflammation and subsequently changing to immunomodulatory therapy (IMT) for long-term treatment.
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Affiliation(s)
- Paola A. Rivera
- Department of Ophthalmology and Visual Science, School of Medicine, Yale University, New Haven, CT, USA
| | - Akash Gupta
- Department of Medicine, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Ninani Kombo
- Department of Ophthalmology and Visual Science, School of Medicine, Yale University, New Haven, CT, USA
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Ali Khan H, Ali Khan Q, Shahzad MA, Awan MA, Khan N, Jahangir S, Shaheen F, Wali K, Rodman J, Pizzimenti J, Saatci AO. Comprehensive overview of IRVAN syndrome: a structured review of Case Reports and Case Series. Ther Adv Ophthalmol 2022; 14:25158414211070880. [PMID: 35282003 PMCID: PMC8905214 DOI: 10.1177/25158414211070880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/13/2021] [Indexed: 12/29/2022] Open
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.
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Affiliation(s)
- Hashim Ali Khan
- Department of Ophthalmology, SEHHAT Foundation Hospital, Danyor, Gilgit 15100, Pakistan
- School of Optometry, The University of Faisalabad, Faisalabad, Pakistan
- Advance Eye Care, Gilgit, Pakistan
| | - Qaim Ali Khan
- Ophthalmology Department, Agha Khan Health Services, Gilgit, Pakistan
| | | | - Muhammad Amer Awan
- Ophthalmology Department, Shifa International Hospital and Shifa College of Medicine, Islamabad, Pakistan
| | | | - Smaha Jahangir
- School of Optometry, The University of Faisalabad, Faisalabad, Pakistan
| | - Fiza Shaheen
- Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | | | - Julie Rodman
- Broward Eye Care Institute, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Jozeph Pizzimenti
- Rosenberg School of Optometry, University of the Incarnate Word, San Antonio, TX, USA
| | - Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University, İzmir, Turkey
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