Will Ayliffe Ph.D, FRCS.
Consultant Ophthalmic Surgeon
St Anthony’s Hospital
To review the current state of knowledge of inflammation of the retinal vessels.\
In 2004 the Standardization of Uveitis Nomenclature Working Group “provisional” consensus was that retinal vasculitis is a descriptive term for evidence of ocular inflammation and retinal vascular changes.
Clearly it remains an enigmatic, but nevertheless potentially devastating blinding condition, characterised by vascular sheathing identified by ophthalmoscopy or vascular leakage on fluorescein angiography.
It occurs as part of ocular inflammatory disease and uveitis, associated with reports have identified intracameral vancomycin used in cataract surgery to be linked to devastating post-operative ischaemic vasculitis3.
Visual loss is frequent, mainly caused by macular edema, ischaemia and haemorrhage.
Because of the heterogenous nature of the condition controlled clinical trials are difficult to organise. Until the recent Oregon study1, large retrospective cohorts from 20 years ago were the main source of information2.
For the time being our knowledge about these various conditions will depend on careful clinical observation and the reports of case series. Because of this who to treat, when to treat and how to treat remain idiosyncratic.
Consensus suggests that most cases require therapy, usually with oral corticosteroids and approximately half will require immune-suppressive therapy.
The role of biologics is evolving.
Surgery, with laser, cryotherapy and vitrectomy is useful in particular cases.
Prior to initiating treatment it is imperative to rule out infectious causes.
Ku et al: Arch Ophthalmol. 2012;130(10):1261-1266.
Graham et al. Br J Ophthalmol. 1989;73(9):714-721.
Witkin et al. Ophthalmology. 2015; 122, (7)1438–1451
Diopsys plc helped with travel expenses.