Ocular complications in retinal vasculitis
Reviewed by Efrosini Papagiannuli

In this retrospective study the authors aimed to characterise the incidence rates of visual loss and ocular complications associated with retinal vasculitis (RV – annual incidence of 1-2/ 100000/ per annum). A secondary objective was to compare the visual outcomes and complications in eyes with relapsing versus non-relapsing retinal vasculitis. Vascular leakage can lead to exudation and macular oedema, with other complications including retinal ischaemia, neovascularisation, vitreous haemorrhage, tractional retinal detachment (TRD), epiretinal membranes (ERM), and neovascular glaucoma leading (NVG) to visual loss; 175 eyes of 96 patients were analysed from 2003 to 2013. RV was diagnosed clinically and evidence of vascular occlusion or leakage confirmed on fluorescein angiogram (FA). Further investigations such as OCT, VF, ERG, CXR, ACE, Quantiferon test, MRI, HLA-B27 etc. were done as indicated. The decision to treat was made according to medical judgement and the presence of disease activity at each clinic visit was used to determine the rate of relapse (presence of new disease activity in a previously quiescent eye). In this cohort 82.3% patients had bilateral disease, 14.6% had a family history of autoimmune disease and the mean disease duration at the time of presentation was 4.9 months; 59.4% had no associated medical disease, whereas 40.6% had an underlying systemic aetiology, the commonest being Behcet’s disease (10.4%) and sarcoidosis (9.4%). At presentation 36% had VA of <20/50, and 20% of <20/200. 28.6% had vascular sheathing and 6.3% presented with vascular occlusion / non-perfusion;11.4% of patients had associated retinal haemorrhages and 55.4% active intraocular inflammation (34% anterior chamber activity, 41.7% vitritis). A total of 14.9% presented with macular oedema, 4% had CNV, 16% ERM and 2.3% a retinal detachment; 25.1% had a cataract at presentation. The majority of patients were already on treatment at the time of presentation with 39.6% taking systemic steroids, 22.3% topical steroids, and 14.6% immunosuppresants. During the follow-up period 75.3% started systemic steroids and 48.2% immunosuppresants. Follow-up data was available for 81/96 patients (84%) with a median of 3.67 years and an incidence rate of visual acuity loss to <20/50 of 0.13/EY and to <20/200 of 0.06/EY respectively. Forty-six eyes developed cataract or had progression of previous cataract with an incidence of 0.31/EY, necessitating cataract surgery in 17/46 eyes. The incidence rate for recurring CMO was 0.09/EY, for ERM 0.16/EY, and for CNV, vascular occlusion, scarring and optic neuropathy 0.01/EY. Smokers had a threefold risk of developing VA<20/50 and twofold risk of VA<20/200. Patients with a relapsing course also were at greater risk for visual loss <20/50 (odds ratio 2.07) and <20/200 (odds ratio 2.49), with immunosuppressive treatment decreasing the risk of visual loss regardless of the course of the disease. The authors acknowledge the study’s limitations due to its retrospective nature, the variable follow-ups, the modest sample size and the likelihood of referral bias as all patients were seen in a single tertiary medical centre.

Clinical features and incidence rates of ocular complications in patients with retinal vasculitis.
Mir TA, Reddy AK, Burkholder BM, et al.
AMERICAN JOURNAL OF OPHTHALMOLOGY
2017;179:171-8.