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Management and Treatment Response of Patients with Primary Retinal Vasculitis
Presenter:
Leena Suapaneni
Authors:
Leena Surapaneni, Paola A. Rivera, Akash Gupta, Ritika Segireddy, Ninani Kombo
1. Yale School of Medicine, New Haven, CT
2. Department of Ophthalmology, Yale School of Medicine, New Haven, CT
3. Department of Medicine, Yale School of Medicine, New Haven, CT
4. Department of Ophthalmology, Yale School of Medicine, New Haven, CT
5. Geisinger Commonwealth School of Medicine, Scranton, PA
Affiliation:
Purpose: Primary retinal vasculitis (PRV) is a sight-threatening ocular inflammatory condition. Management varies widely with the use of systemic steroids, immunomodulatory therapies, and intravitreal steroid injections. This study describes the treatment course of patients PRV at a major tertiary center.
Methods: This retrospective case series included patients over the age of 18 years diagnosed with PRV. Patients with any infectious causes, autoimmune diseases, or other ocular pathology were excluded. PRV was diagnosed clinically by documenting perivascular sheathing, intraretinal hemorrhage, cotton–wool spots, vascular occlusion, and vascular leakage. Recorded demographic and clinical data included chief complaint, findings on dilated fundoscopic exam and intravenous fluorescein angiography, laboratory testing, treatment, and dates of recurrence and remission.
Results: There were 33 eyes from 17 patients, 59% of whom were female, with a mean age of 61 years (Table 1 and Table 2). The disease was bilateral in 94% of patients and 30.3% of patients had best corrected visual acuity (BCVA) <20/40. All patients underwent comprehensive lab testing with 6 patients having an incidentally positive ANA. The average follow-up period was 57 months. 2 patients achieved a stable exam without treatment. Initial treatment for patients included systemic steroids (68.8%), after which immunomodulatory therapies (58.5%), and intravitreal injections of steroids (31.3%) were utilized. 12 patients achieved quiescence following initial management within an average of 30.9 months while 3 patients never achieved quiescence during the follow-up period. 5 patients experienced recurrent vasculitis flares within an average of 16.4 months. 6 patients experienced treatment failure or adverse effects, such as hyperglycemia on prednisone and pancreatitis on mycophenolate, and required a medication switch. 4 patients were discontinued systemic treatment due to remission. Final BCVA was ≥20/40 in 58.1% of patients.
Conclusions: PRV often requires multiple and prolonged treatment strategies for controlling inflammation with local and systemic therapies. Good vision can be preserved with treatment. Due to the wide variability in treatment outcomes, more refined studies and algorithms can guide treatment of PRV.