Dr. Sahil Jain
Resident, AIIMS
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Retina Vitreous › Retinal Vasculitis
Fundus photo showing Retinal Arteritis
Retinal vasculitis has four stages: 1. Inflammation — Active disease: perivascular whitish cuffing, retinal edema/hemorrhage, cystoid macular edema, vitreous snowballs, and inflammatory vascular occlusions. May coexist with choroiditis, retinitis, or uveitis. Rule out infection first. Unilateral, macula-involving noninfectious disease → periocular/intravitreal steroids (after excluding glaucoma/steroid response); oral steroids if periocular is contraindicated. Bilateral macular involvement → oral steroids or sequential periocular steroid injections. Role of steroids in peripheral, non-macular disease is controversial. 2. Ischemia — Sclerosed vessels, tortuous collaterals, possible healed choroiditic patches. Fluorescein angiography shows capillary nonperfusion without neovascularization. Usually just monitored; collaterals should not be lasered, as they represent a healing/revascularization response. 3. Neovascularization — Often presents as vitreous hemorrhage. Treatment: laser photocoagulation of nonperfused areas identified on angiography. 4. Complications — Nonresolving vitreous hemorrhage, tractional or combined retinal detachment, epiretinal membrane, neovascular glaucoma, iris neovascularization. Managed with vitrectomy and/or filtration surgery. Predominantly involved vessels 1. Artery: Acute retinal necrosis, idiopathic retinal vasculitis, aneurysm and neuroretinitis, systemic lupus erythematosus, polyarteritis nodosa, syphilis, progressive outer retinal necrosis, and Churg-Strauss syndrome 2. Vein: Eales disease, intermediate uveitis, sarcoidosis, multiple sclerosis, tuberculosis, birdshot chorioretinitis, and HIV paraviral syndrome 3. Both artery and vein: Frosted branch angiitis, toxoplasmosis, relapsing polychondritis, granulomatosis with polyangiitis (formerly Wegener's granulomatosis), and Crohn's disease
Retina Vitreous › Retinal dialysis
Chorioretinal Sclopetaria
Chorioretinal sclopetaria/traumatic chorioretinitis is a severe ocular injury caused by a high-velocity projectile (such as a bullet or BB pellet) that passes near or strikes the eye without rupturing the sclera. The resulting shockwave ruptures the choroid and retina, causing them to split and retract, which exposes the bare white sclera.