Ranibizumab for idiopathic retinal vasculitis, aneurysms, and neuroretinitis: favorable results

Idiopathic retinitis, vasculitis, aneurysms, and neuroretinitis (IRVAN) is a rare syndrome that can progress rapidly to severe visual loss mainly due to the development of proliferative retinopathy despite aggressive therapeutic retinal photocoagulation or pars plana vitrectomy. We report a case of IRVAN treated with ranibizumab as an adjunctive treatment of IRVAN.

Interventional case report. A 50-year-old woman was diagnosed with IRVAN. Complete ocular and systemic examination and fundus fluorescein angiography were performed to evaluate the patient. Treatment with 2 monthly intravitreal injections of 0.5 mg ranibizumab was initiated for each eye followed by panretinal photocoagulation (PRP) in the right eye (RE) and pars plana vitrectomy, endolaser, and additional PRP in the left eye (LE).

Immediate regression of optic nerve neovascularization in the RE was noted after ranibizumab treatment. One year after initial presentation, best-corrected visual acuity was 20/20 in the RE and 20/50 in the LE and results of fundus examination have shown complete regression of neovascularization bilaterally.

We propose a modified treatment modality for stage 3 IRVAN with the adjunctive use of ranibizumab. Our patient has shown complete regression of posterior segment neovascularization accompanied with significant improvement of her visual acuity. Ranibizumab seems to have encouraging results as an adjunctive treatment of IRVAN.