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Idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN): case series of three patients with multimodal imaging

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Abstract

Purpose

The purpose of this study was to report the clinical presentation, disease progression, treatment and complications of IRVAN.

Method

Case series

Patients

Six eyes from three patients were included.

Results

All eyes were treated with pan-retinal photocoagulation (PRP). One eye received Ozurdex (dexamethasome implant) for persistent macular exudates and oedema. One eye received Avastin injections for retinal neovascularization. Oral steroids were given to all patients at some point during the disease process. One patient had additional immunosuppression with mycophenolate mofetil. Despite aggressive PRP, the visual outcomes varied widely. One patient maintained 6/6 vision bilaterally at 84 months follow-up. The second patient had progressive visual loss secondary to macular exudates and oedema, from 6/9 right eye, 6/6 left eye to 6/18 right eye, 6/60 left eye within 12 months despite Ozurdex injection. The third patient’s vision at presentation was 6/5 right eye, and 6/4 left eye. Despite further interventions including Avastin and mycophenolate mofetil, he continued to have progressive neovascularization and recurrent vitreous haemorrhage. At 72 months, his vision had deteriorated to 6/60 right eye, 6/18 left eye.

Conclusion

The progression of IRVAN can vary greatly, in spite of aggressive treatment with PRP, oral and intravitreal steroids, immunosuppressant medication and anti-VEGF agents. The variation in disease progression occurs both within the same individual as well as between individuals. An individualised approach to therapy is advocated.

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Author information

Authors and Affiliations

  1. Birmingham Midland Eye Centre, 76 Dudley Rd., Birmingham, B18 7QH, UK

    Yu Jeat Chong & Ambreen Sarmad

  2. Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK

    Abison Logeswaran

  3. Addenbrookes Hospital, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 0QQ, UK

    Erika Marie Damato

Authors
  1. Yu Jeat Chong
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  2. Abison Logeswaran
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  3. Ambreen Sarmad
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  4. Erika Marie Damato
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Corresponding author

Correspondence to Yu Jeat Chong.

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Conflict of interest

Dr. Erika Marie Damato has received speaker fees from AbbVie and Novartis in the past 12 months. All the other authors declare that they have no conflict of interest

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Consent not required due to retrospective, anonymous and observational nature of this series. The study was performed at the Birmingham Midland Eye Centre. This research was presented at the European Association for Vision and Eye Research conference in NICE (2017). There are no proprietary interests to declare.

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Chong, Y.J., Logeswaran, A., Sarmad, A. et al. Idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN): case series of three patients with multimodal imaging. Graefes Arch Clin Exp Ophthalmol 257, 1013–1018 (2019). https://doi.org/10.1007/s00417-019-04291-5

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  • DOI: https://doi.org/10.1007/s00417-019-04291-5

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