Acute retinal periphlebitis mimicking frosted branch angiitis associated with exudative retinal detachment after...

We report a case of a 14-year-old otherwise healthy patient who developed acute retinal periphlebitis mimicking frosted branch angiitis inferotemporally and associated exudative retinal detachment in the left eye following blunt trauma. Fluorescein angiography revealed delayed filling of inferotemporal branch retinal vein and late leakage of sheathed retinal venules, and late pooling in the area of exudative retinal detachment. Indocyanine green angiography showed a crescent-shaped hypofluorescent streak concentric to the optic disk inferiorly highly suggestive of choroidal rupture. The patient was treated with oral prednisone, with gradual tapering over a period of 15 days. One month after presentation, retinal vein sheathing and exudative retinal detachment had resolved, with the development of peripapillary subretinal fibrosis, macular atrophy, pseudomacular hole, and epiretinal membrane. The acute perivenular sheathing in our patient might be related to autoimmune-mediated reaction induced by retinal vascular damage caused by severe ocular trauma. Fluorescein angiography and indocyanine green angiography findings might suggest that the retinal detachment could be caused by leakage from choroid through Bruch's membrane and retinal pigment epithelium rupture or by transient dysfunction of the outer or inner blood-retinal barrier.