Diagnosing retinal vasculitis and its implications for treatment

ABSTRACT

Introduction: Retinal vasculitis (RV) is a sight-threatening intraocular inflammatory condition involving retinal blood vessels. Discrimination between infectious and noninfectious etiologies is mandatory to appropriate management and favorable outcome.

Areas covered: A comprehensive literature review between January 1986 and January 2019 was conducted in PubMed database. Pathophysiology, clinical and imaging features, differential diagnosis, treatment, and prognosis of RV were reviewed.

Expert opinion: In any patient with RV, a tailored diagnostic approach is recommended. A masquerade syndrome should always be excluded first, and then an infectious cause must be ruled out before corticosteroid or immunosuppressive therapy can be considered. Clinician also should be aware of sight-threatening complications that may affect visual prognosis.

KEYWORDS:

• Retina
• vasculitis
• uveitis
• fluorescein angiography
• corticosteroids
• immunosuppressive therapy

Article highlights

• Retinal vasculitis (RV) is a sight-threatening condition characterized by inflammation of retinal vessels most commonly involving veins (periphlebitis) and/or capillaries (capillaritis) than arteries (periarteritis).

• Fluorescein angiography, OCTA, and OCT are essential tools in detecting RV, assessing the disease activity, complications, and extent of retinal damage, and in guiding therapy.

• A tailored diagnostic approach, based on clinical history, systemic and ocular symptoms and signs, pattern of vascular involvement, and associated ocular findings, is recommended in workup of patients with RV.

• It is mandatory that a masquerade syndrome be excluded and that an infectious cause be ruled out first before corticosteroid or immunosuppressive therapy can be considered.

• Most common sight-threatening complications of RV include macular edema, retinal ischemia, and vasoproliferative complications.

• Infectious RV must be treated with the appropriate antimicrobial agents. Adjunctive corticosteroid therapy may be required to control associated inflammatory reaction, but it should never be used alone.

• Systemic corticosteroids and immunosuppressant agents remain the mainstay of therapy in noninfectious RV, and the advent of biologics agents helps immensely in the management of RV.

• Adjunctive treatment modalities (e.g., anti-VEGF agents, laser photocoagulation, surgery, etc.) should be considered for the treatment of specific secondary complications.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.