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
