Epidemiology, Clinical Features, Therapies, and Outcomes of Patients Diagnosed with Inflammatory Retinal Vascular Occlusions.

Abstract

Purpose : In a subset of patients with retinal vasculitis, occlusion of blood flow through inflamed retinal vessels may occur. These cases have not been studied independently. The index retrospective cohort study aimed to characterize the epidemiology, clinical course, imaging features, treatment, and outcomes of inflammatory retinal artery and vein occlusion (IRAO and IRVO).

Methods : Clinical and imaging data from two large tertiary-care uveitis centers in India and USA were reviewed to identify patients with retinal vasculitis. Patients with occlusive retinal vasculitis (capillary, arteriolar and/or venular occlusion), confirmed by clinical and imaging tests, were further analyzed. The diagnostic criteria for occlusive vasculitis included presence of: angiographic vascular occlusion, capillary non-perfusion areas, arterio-venous anastamosis, vitreous hemorrhage, or intraretinal hemorrhages and cotton-wool spots. Outcome measures included final best-corrected visual acuity (BCVA), treatment and rates of complications.

Results : Records of 2438 uveitis patients were screened. 346 patients were diagnosed with retinal vasculitis of which 77 patients (96 eyes) were diagnosed with IRAO and/or IRVO. The mean age of the patients diagnosed with occlusive retinal vasculitis was 32.09 ± 13.51 years. Most common etiologies were tuberculosis (TB) (34.37%) and Behçet’s disease (BD) (5.21%) in India and systemic lupus erythematosus (SLE) (6.25%) in the US cohort. 78.48% patients required therapy with systemic steroids. In addition, the majority of patients required aggressive concomitant therapy with immunomodulators and/or biologics (with or without anti-TB drugs). BCVA improved from 0.37 ± 0.31 at presentation to 0.23 ± 0.29 LogMAR units at the final visit (p<0.0001). 45.94% eyes required scatter laser photocoagulation for neovascularization. Vitreous hemorrhage was seen in 31.08% eyes. Pars plana vitrectomy was performed in 12.16% eyes. Three eyes developed inoperable retinal detachment during the course of the disease.

Conclusions : IRAO and/or IRVO are caused by heterogeneous group of uveitic diseases based on the geographic location and endemicity. Eyes with occlusive retinal vasculitis are predisposed to high rates of complications and require aggressive therapy with immunomodulators and biologic agents.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.