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Jacqueline Busingye, Sergio Schwartzman, Jessica Ackert, Thomas Flynn; Treatment Paradigms in Retinal Vasculitis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5377.
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Currently there are no definitive treatment paradigms for retinal vasculitis complicated by vaso-obliterative disease. Here we present 4 cases of patients exhibiting retinal vasculitis complicated by branch vein occlusion.
Retrospective chart review from 2009-2012 for diagnosis codes of retinal vasculitis. Charts of patients with this diagnosis were reviewed. Only those patients who had leakage of retinal blood vessels in addition to occlusive disease as manifested by angiographic and clinical evidence of venous occlusion were included in this analysis.
4 out of 4 patients were found to have an associated underlying systemic condition. One patient was diagnosed with SLE, one patient with sarcoid, one patient with psoriasis, and one patient with anklyosing spondylitis. All patients required treatment with prednisone and anti-metabolite therapy. 2 of the 4 patients were noted to have progressive disease activity despite prednisone and anti-metabolite therapy as manifested by new occlusive activity. In those patients, anti TNF-alpha (infliximab) therapy was initiated. Following the change in medication regiment, those patients were stable for over a year without evidence of recurrent disease activity. All patients have retained stable or improved visual acuity from baseline without significant medication side effects.
Our small case series suggests a significantly higher rate of underlying systemic disease in patients presenting with retinal vasculitis complicated by vaso-occlusive disease than what has been reported in previous studies. Patients presenting with this clinical picture require aggressive immunosuppressive agents. Initial therapy of a tapering dose of prednisone in conjunction with anti-metabolite therapy may not offer optimal control in all patients. In this study, half of the patients required anti-TNF therapy to achieve control of the ophthalmic disease. Further study is needed to better delineate optimal treatment paradigms.
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