Retinal Capillary Reperfusion from Ischemic Retinal Vasculitis in Henoch–Schönlein Purpura: A Case Report

ABSTRACT

Introduction

We present a case of ischemic retinal vasculitis in adult-onset Henoch–Schönlein purpura (HSP) and the first report of capillary reperfusion through regenerative angiogenesis using optical coherence tomography angiography (OCTA).

Case report

A 34-year-old male complained of bilateral blurred vision after successive episodes of abdominal pain, purpura, and hematuria. Fundus examination showed perivascular infiltration and phlebitis. Fluorescein angiography and OCTA revealed extensive capillary nonperfusion. Laser photocoagulation was performed on the peripheral nonperfused area. Intravenous methylprednisolone with azathioprine was administered and continuously tapered. With consecutive OCTA follow-up, the capillary nonperfusion of the maculae progressively reperfused. Capillary buds and loops emerged within the nonperfused area, continued to elongate and branch, and finally connected with adjacent preexisting capillaries.

Conclusions

Regenerative angiogenesis was the mainstay process for capillary reperfusion in this patient. Systemic steroid therapy might support capillary reperfusion and recover the damaged ischemic maculae from ischemic retinal vasculitis of HSP.

KEYWORDS:

• Capillary reperfusion
• Henoch–Schönlein purpura
• ischemic retinal vasculitis
• optical coherence tomography angiography
• regenerative angiogenesis

Authors’ contributions

HJK and JEL examined the patient and interpreted the imaging. MSK drafted the manuscript and prepared the figures. All authors read and approved the final version of the manuscript.

Consent for publication

Written informed consent was obtained from the patient for the publication of this case report and any accompanying images.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Ethics approval

Ji Eun Lee has the following disclosures to make; Bayer (consultant, honoraria, travel grant, and research fund), Novartis (consultant, honoraria, and research fund), Allergan (consultant and honoraria), Alcon (honoraria), and Abbvie (consultant and honoraria). The other authors have no potential conflict of interest with this article. The authors take sole responsibility for the content and writing of this manuscript.