Differential Diagnosis of Retinal Vasculitis

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Abstract

Retinal vaculitis is a sight-threatening inflammatory eye condition that involves the retinal vessels. Detection of retinal vasculitis is made clinically, and confirmed with the help of fundus fluorescein angiography. Active vascular disease is characterized by exudates around retinal vessels resulting in white sheathing or cuffing of the affected vessels. In this review, a practical approach to the diagnosis of retinal vasculitis is discussed based on ophthalmoscopic and fundus fluorescein angiographic findings.

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Standard diagnostic criteria for the acute retinal necrosis syndrome. Executive Committee of the American Uveitis Society.

Daniel G Holland (1994)

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Viral causes of the acute retinal necrosis syndrome.

Jyotsom B Ganatra, Diane J. Chandler, Carmen Santos … (2000)

The primary goal of this study was to determine the viral cause of the acute retinal necrosis syndrome in 28 patients (30 eyes). A secondary goal was to investigate possible associations between viral cause and patient age, and viral cause and central nervous system disease. A retrospective case series in which we reviewed the laboratory results and clinical histories of 28 patients (30 eyes) diagnosed with acute retinal necrosis syndrome, from whom vitreous or aqueous specimens were received, for diagnostic evaluation using previously described polymerase chain reaction-based assays. Varicella-zoster virus, herpes simplex virus, and cytomegalovirus (CMV) DNA were detected in aqueous and/or vitreous specimens from 27 of 28 patients (29 of 30 eyes with a clinical history of acute retinal necrosis syndrome). No sample was positive for DNA from more than one virus. Varicella-zoster virus DNA was detected in 13 patients (15 eyes). Median age was 57 years. Herpes simplex virus type 1 DNA was detected in seven patients (seven eyes). Median age was 47 years. Six of these patients had a history of herpes simplex virus encephalitis. Herpes simplex virus type 2 DNA was detected in six patients (six eyes). Median age was 20 years. Three of these patients had a likely history of meningitis. Cytomegalovirus DNA was detected in one patient who was immunosuppressed iatrogenically. No viral DNA was detected in one patient from whom a sample was taken after 6 weeks of acyclovir therapy. The data suggest that varicella-zoster virus or herpes simplex virus type 1 cause acute retinal necrosis syndrome in patients older than 25 years, whereas herpes simplex virus type 2 causes acute retinal necrosis in patients younger than 25 years. A history of central nervous system infection in a patient with acute retinal necrosis syndrome suggests that herpes simplex virus is likely to be the viral cause.

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Ocular complications of Rift Valley fever outbreak in Saudi Arabia.

Ali Hazmi, Lubna N Ahmed, Mohammed Al Dosari … (2005)

To report ocular complications of Rift Valley fever (RVF) during its first reported outbreak in southwest Saudi Arabia in autumn 2000. Cross-sectional study of patients in a referral hospital. One hundred forty-three consecutive patients with confirmed RVF serologic test results and ocular lesions were enrolled in the study. Hospitalized patients (n = 30) and outpatients (n = 113) with clinical symptoms consistent with RVF, positive RVF serologic test results, and ocular abnormalities were studied. Ophthalmologic examinations, including fundus photography and fluorescein angiography, were performed. Patients were followed up at regular intervals to determine the prognosis and outcome of identified ocular abnormalities. Visual acuity at initial presentation and course of anterior and posterior segment complications. Among 143 patients (78% males; mean age, 53.2 years), 212 eyes were affected, comprising 47 eyes in 30 inpatients and 165 eyes in 113 outpatients. The mean interval between the onset of RVF and visual symptoms ranged from 4 to 15 days (mean, 8.8 days). Macular or paramacular retinitis was identified in all the affected eyes (n = 212) at the time of initial assessment. Lesions included retinal hemorrhages (40%), vitreous reactions (26%), optic disc edema (15%), and retinal vasculitis (7%). Anterior uveitis was present in 31% of outpatients. Fluorescein angiography of the retinitis showed early hypofluorescence with late staining of retinal lesions and blood vessels. Initial visual acuity was less than 20/200 in 80% of eyes in the outpatient group; their vision improved, deteriorated, or remained the same in 13%, 15%, or 72%, respectively. Evaluation at the last follow-up showed macular (60%) or paramacular (9%) scarring, vascular occlusion (23%), and optic atrophy (20%) in the outpatient group. Rift Valley fever was associated with major ocular morbidity. Ocular manifestations of RVF occurred with a relatively higher frequency than reported up to now and were not limited to severe infections. Rift Valley fever affects the uvea and posterior chorioretinal area and is associated with permanent visual loss resulting from macular and paramacular scarring, vascular occlusion, and optic atrophy. The study demonstrated for the first time that transient nongranulomatous anterior uveitis is associated with RVF.

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Author and article information

Journal

Journal ID (nlm-ta): Middle East Afr J Ophthalmol

Journal ID (publisher-id): MEAJO

Title: Middle East African Journal of Ophthalmology

Publisher: Medknow Publications (India )

ISSN (Print): 0974-9233

ISSN (Electronic): 0975-1599

Publication date (Print): Oct-Dec 2009

Volume: 16

Issue: 4

Pages: 202-218

Affiliations

Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia

[1 ]Inflammatory and Retinal Eye Diseases, Center for Ophthalmic Specialized Care and University of Lausanne, Lausanne, Switzerland

[2 ]The Eye Center and The Eye Foundation for Research in Ophthalmology, Riyadh, Saudi Arabia

Author notes

Corresponding Author:Prof. Ahmed M. Abu El-Asrar, Department of Ophthalmology King Abdulaziz University Hospital Airport Road, P.O. Box 245, Riyadh 11411, Saudi Arabia. E-mail: abuasrar@ 123456ksu.edu.sa

Article

Publisher ID: MEAJO-16-202

DOI: 10.4103/0974-9233.58423

PMC ID: 2855661

PubMed ID: 20404987

SO-VID: 90f5f51a-dff8-4030-994d-4abbf84b78c0

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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Differential Diagnosis of Retinal Vasculitis

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Karger: Ophthalmology

Most cited references 100

Standard diagnostic criteria for the acute retinal necrosis syndrome. Executive Committee of the American Uveitis Society.

Viral causes of the acute retinal necrosis syndrome.

Ocular complications of Rift Valley fever outbreak in Saudi Arabia.

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