Download Case Report 7.88

Atypical IRVAN presentation
Piergiorgio Neri, MB ChB, MD, PhD
Head of Ocular Inflammation Unit
Ospedali Riuniti di Ancona
Ocular History
• 43 year old man
• 5-2006: LE severe visual decrease
• No systemic problems
• Tests performed not contributory
May 2006: First presentation
• BCVA: RE 20/20, LE 20/400
• No cells in the anterior chamber, no cell in the
vitreous
• Fundus RE: normal
• Funsus LE:
– Retinal vasculitis
– Multiple macroaneurysms
– Neuroretinitis
Treatment
• Panretinal photocoagulation
– IMPROVEMENT
March 2007
• BCVA: RE 20/20, LE 20/200
• Mild visual disturbances
• Fundus RE: central retinal vasculits with retinal
ischemia
• Fundus LE: stable after PRP
Treatment
• Oral prednisone (1mg/Kg/day) associated with
mycophenolate mofetil (1g twice/day)
– IMPROVEMENT
June 2007
• BCVA: RE 20/20, LE 20/200
• No complaints
• Fundus RE: microvascular abnormalities with no
signs of retinal vasculitis
•FA in the RE: retinal ischemia in the temporal side
• Fundus LE: stable after PRP
Treatment
• Pattern Scan Laser (PASCALTM) Photocoagulation of
ischemic areas
– IMPROVEMENT
Problems
• Asynchronous occurrence
• No guidelines for the therapy
• Pathophysiology (is IRVAN secondary to a vasoocclusive vasculitis?)
Conclusion
• IRVAN is generally bilateral, even though the
involvement of the eyes is not always synchronous
• Systemic investigations are generally not
contributory
• It is possible that IRVAN can have a prodromic phase
with ischemic retinal vasculitis
• Systemic steroids and immunesuppression are
generally not helpful, but this can be not true, if
applied in the prodromic phase
• Argon laser photocoagulation is mandatory for cases
with retinal ischemia