TREATMENT OF IDIOPATHIC RETINAL VASCULITIS, ANEURYSMS, AND NEURORETINITIS (IRVAN) WITH PHOTOCOAGULATION IN COMBINATION WITH SYSTEMIC IMMUNOSUPPRESSION.
Aneurysm
/ diagnosis
Coloring Agents
/ administration & dosage
Combined Modality Therapy
Fluorescein Angiography
Humans
Immunosuppressive Agents
/ therapeutic use
Indocyanine Green
/ administration & dosage
Laser Coagulation
Male
Methylprednisolone
/ therapeutic use
Middle Aged
Mycophenolic Acid
/ therapeutic use
Retinal Vasculitis
/ diagnosis
Retinal Vessels
/ pathology
Retinitis
/ diagnosis
Journal
Retinal cases & brief reports
ISSN: 1937-1578
Titre abrégé: Retin Cases Brief Rep
Pays: United States
ID NLM: 101298744
Informations de publication
Date de publication:
2020
2020
Historique:
pubmed:
21
12
2017
medline:
17
7
2021
entrez:
21
12
2017
Statut:
ppublish
Résumé
Idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome is a very rare primary retinal vasculitis. It seems to evolve in stages, where there is initially a florid vasculitis associated with aneurysm formation. Neuroretinitis and macula edema are common features. Subsequently, retinal ischemia ensues, leading to neovascularization. If untreated, further sight-threatening complications occur, including traction retinal detachment and secondary glaucoma. Here, we describe a patient with early idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome, who was treated with a combination of systemic immunosuppression and localized photocoagulation. There was substantial regression of the aneurysms and improvement of the macular edema. Treatment of the disorder should be based on the clinical stage and complications of the disorder. As shown here, a multidisciplinary approach can be very helpful in managing patients with this severe sight-threatening disorder.
Sections du résumé
BACKGROUND
BACKGROUND
Idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome is a very rare primary retinal vasculitis. It seems to evolve in stages, where there is initially a florid vasculitis associated with aneurysm formation. Neuroretinitis and macula edema are common features. Subsequently, retinal ischemia ensues, leading to neovascularization. If untreated, further sight-threatening complications occur, including traction retinal detachment and secondary glaucoma.
METHODS AND RESULTS
RESULTS
Here, we describe a patient with early idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome, who was treated with a combination of systemic immunosuppression and localized photocoagulation. There was substantial regression of the aneurysms and improvement of the macular edema. Treatment of the disorder should be based on the clinical stage and complications of the disorder.
CONCLUSIONS
CONCLUSIONS
As shown here, a multidisciplinary approach can be very helpful in managing patients with this severe sight-threatening disorder.
Identifiants
pubmed: 29261555
doi: 10.1097/ICB.0000000000000692
pii: 01271216-202001440-00011
doi:
Substances chimiques
Coloring Agents
0
Immunosuppressive Agents
0
Mycophenolic Acid
HU9DX48N0T
Indocyanine Green
IX6J1063HV
Methylprednisolone
X4W7ZR7023
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
334-338Références
Samuel MA, et al. Idiopathic retinitis, vasculitis, aneurysms, and neuroretinitis (IRVAN): new observations and a proposed staging system. Ophthalmology 2007;114:1526–1529.e1521.
Kincaid J, Schatz H. Bilateral retinal arteritis with multiple aneurysmal dilatations. Retina 1983;3:171–178.
Nourinia R, et al. Idiopathic retinal vasculitis, aneurysms and neuroretinitis syndrome associated with positive perinuclear antineutrophil cytoplasmic antibody. J Ophthalmic Vis Res 2011;6:330–333.
Soheilian M, et al. Idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome associated with positive perinuclear antineutrophil cytoplasmic antibody (P-ANCA). Retin Cases Brief Rep 2010;4:198–201.
Chang TS, et al. Idiopathic retinal vasculitis, aneurysms, and neuro-retinitis. Retinal Vasculitis Study. Ophthalmology 1995;102:1089–1097.
Sashihara H, Hayashi H, Oshima K. Regression of retinal arterial aneurysms in a case of idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN). Retina 1999;19:250–251.
Tomita M, et al. Long term follow up in a case of successfully treated idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN). Br J Ophthalmol 2004;88:302–303.
Basha M, et al. Management of IRVAN syndrome with observation. Ophthalmic Surg Lasers Imaging Retina 2014;45:e18–e22.
Empeslidis T, et al. Dexamethasone intravitreal implant for idiopathic retinal vasculitis, aneurysms, and neuroretinitis. Eur J Ophthalmol 2013;23:757–760.
Moosavi M, et al. Unilateral idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome (IRVAN) in a young female. J Curr Ophthalmol 2015;27:63–66.
Karagiannis D, et al. Ranibizumab for idiopathic retinal vasculitis, aneurysms, and neuroretinitis: favorable results. Eur J Ophthalmol 2010;20:792–794.
Sawhney GK, et al. Combination anti-VEGF and corticosteroid therapy for idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome. Ophthalmic Surg Lasers Imaging Retina 2013;44:599–602.
Cheema RA, Al-Askar E, Cheema HR. Infliximab therapy for idiopathic retinal vasculitis, aneurysm, and neuroretinitis syndrome. J Ocul Pharmacol Ther 2011;27:407–410.
Singh R, et al. Vanishing retinal arterial aneurysms with anti-tubercular treatment in a patient presenting with idiopathic retinal vasculitis, aneurysms, and neuroretinitis. J Ophthalmic Inflamm Infect 2016;6:8.
Vichare N, et al. A rare case of idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) syndrome. Med J Armed Forces India 2015;71:S257–S260.
Saatci AO, et al. Single bilateral dexamethasone implant in addition to panretinal photocoagulation and oral azathioprine treatment in IRVAN syndrome. Case Rep Ophthalmol 2015;6:56–62.
Xia Y, et al. Fluorescein photodiagnosis of idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome: a case report and long-term outcome of photocoagulation therapy. Photodiagnosis Photodyn Ther 2016;16:15–16.
MacIver S, Bass SJ, Sherman J. Visual acuity recovery in a case of idiopathic retinal vasculitis aneurysms and neuroretinitis. Optom Vis Sci 2012;89:E356–E363.