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IDIOPATHIC RETINAL VASCULITIS, ANEURYSMS, AND NEURORETINITIS COMPLICATED BY CILIORETINAL ARTERY OCCLUSION: MULTIMODAL
Bruno F A Ferreira1, Rodrigo H Sato1, Lívia S Conci1
1Department of Ophthalmology, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil ; and.
Purpose:
Idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome may be complicated by cilioretinal artery occlusion, resulting in poor final visual acuity despite reperfusion of the occluded artery. Multimodal imaging assessment may be helpful for diagnosis, classification, and monitoring such cases.To describe a multimodal imaging and a 5-year follow-up of a case of cilioretinal artery occlusion in a 40-year-old woman with idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome.
Methods:
Fundus photography, indocyanine green and fluorescein angiography, optical coherence tomography (OCT), OCT angiography (OCTA), and a literature review of retinal artery occlusions associated with idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome were performed.
Results:
Fundus examination revealed bilateral blurred margins of the disks and perivascular hard exudates. Fluorescein angiography demonstrated peripheral capillary nonperfusion areas in both eyes. It also revealed an aberrant cilioretinal artery in the right eye. OCT showed attenuation of the inner retinal layers and disruption of the outer retinal layers secondary to cilioretinal artery occlusion in the right eye. OCTA allowed a clear identification of macular hypoperfusion in both eyes. Laser photocoagulation, along with antivascular endothelial growth factor and corticosteroid intravitreal injections, was administered in both eyes. Best-corrected visual acuity remained stable, with no evidence of progression or development of neovascularization after a 5-year follow-up.
Conclusion:
Idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome may be complicated by cilioretinal artery occlusion, resulting in poor final visual acuity despite reperfusion of the occluded artery. In such cases, multimodal imaging allows the identification of complications such as macular atrophy on OCT and hypoperfusion areas that may not be detected on fluorescein angiography on OCTA.
