This review article summarises the update on non-infectious retinal vasculitis (RV). It is primarily classified based on the type of retinal vessels involved and further sub-classified as occlusive or nonocclusive. Clinically it can occur as an isolated ocular entity or as an association of autoimmune diseases like Behcet’s disease, sarcoidosis, systemic Lupus erythematosus (SLE) and others. Although rare, RV has been reported after Covid-19 and influenza vaccinations. Drug-induced vasculitis has also been widely reported, especially after intravitreal drug delivery. Haemorrhagic occlusive RV has been reported following the injection of aminoglycosides (gentamycin and amikacin), vancomycin, mitomycin-C, cefuroxime, rituximab and brolucizumab into the vitreous cavity. Pathogenesis may involve a type-III hypersensitivity reaction, increased expression of intracellular adhesion molecules, and genetic susceptibility. The armamentarium for management includes anti-inflammatory and immunosuppressive therapy. Treatment may include management of underlying systemic disease. The local delivery of the drugs to the eye can be in the form of intravitreal steroid implants and depot steroid injections (sub-tenons). Severe forms of ocular or systemic involvement may require pulsed intravenous high-dose corticosteroids, disease-modifying antirheumatic drugs, monoclonal antibodies, and TNF alpha inhibitors. Biologic agents such as infliximab or interferon alpha may be required in refractory cases. Anti-VEGF agents are essential in managing macular oedema and neovascular complications of RV. Treating complications like retinal ischemia and neovascular glaucoma requires pan-retinal photocoagulation, and end-stage complications like tractional retinal detachment may require pars plana vitrectomy (PPV) surgery. The treatment often requires a multidisciplinary approach. Limitations: Population heterogenicity, differences in study designs, definitions and methodologies of studies included in the review.
Update: Non-infectious retinal vasculitis
Reviewed by Sofia Rokerya
An update on non-infectious retinal vasculitis.
CONTRIBUTOR
Sofia Rokerya
MBBS MRCOphth FRCSI, King's College University Hospital, UK.
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