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Anna Leszczynska, Laura Pelegrin, Victor Llorens, Ricardo Casaroli, Marc Figueras-Roca, Daniel Rojas, Alfredo Adan; Laboratory Findings And Diagnostic Approach In The Idiopathic Retinal Vasculitis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3213.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the clinical characteristics and diagnostic approach in 7 cases of idiopathic retinal vasculitis followed at our center between March 2004 and October 2011. The hypothesis is that only few laboratory tests ought to be performed in order to discard a vasculitis secondary to a systemic disease.
We retrospectively analyzed the records of 7 patients with the idiopathic retinal vasculitis. All of them underwent slit lamp biomicroscopy, fundus examination, fluorescein retinal angiography, and optic coherence tomography of the macula. A physical examination by an internal medicine specialist and also a total blood count, erythrocyte sedimentation rate and chest roentgenogram was performed in all of the patients. Furthermore 6 of 7 patients (87%) were tested for the presence of anti-nuclear (ANA) and anti-tisular antibodies in the blood plasma. In 57% of the cases the quantiFERON-TB test and tuberculin sensitivity test was performed. 42% of the patients were checked for the presence of anti-Treponema Pallidum antibodies in the blood plasma.
The follow - up time ranged between 1 months and 7 years. The main age was 36,4 years. The most common funduscopic finding was cuffing of the retinal vessels (100%). 71,4% of the patients had a presence of the inflammatory cells in the anterior or vitreous chamber at some stage of the disease. 42,8% developed retinal neovascularization and macular edema. Other findings were cataract (28,5%), vitreous hemorrhage (28,5%) and epiretinal membrane (28,5%). Out of 6 patients screened for the markers of a systemic disease 100% showed positive results for at least on of them. 50% of the patients had positive anti-nuclear antibodies, 33,3% of them showed positive anti - tisular antibodies and tuberculin sensibility test. Out of the 7 patients only one of them developed clinically manifested and confirmed autoimmune disease, which in this case was a multiple sclerosis and showed no relation to the positive result of screening tests.
The results of our study suggest that the laboratory work up of a patient with an isolated retinal vasculitis and no medical history of a systemic disease should be based on diferential diagnosis and thorough physical examination and anamnesis. Furthermore the routine screening for autoimmune and infectious systemic disease markers may lead to confusing results due to their low positive predictive value in the retinal idiopathic vasculitis.
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