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Joseph Christiansen, Robert Prinzi, Ghazala O'Keefe; Treatment Modalities and Visual Outcomes in Retinal Vasculitis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4198.
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© ARVO (1962-2015); The Authors (2016-present)
Retinal vasculitis is an entity that encompasses a wide variety of diagnoses leading to retinal vascular inflammation. We performed a retrospective chart review of all cases of retinal vasculitis seen at Emory Eye Center from 2005 to 2017 in order to evaluate underlying etiologies and trends in treatment modalities and visual outcomes.
We performed a retrospective cohort study searching 12 years of records to find those with a diagnosis of retinal vasculitis over age 18. Associated diagnoses, visual acuity at time of presentation, most recent visual acuity, and modalities of treatment were evaluated. Patients were divided into modality of treatment: systemic immunomodulatory therapy (IMT), oral prednisone only, and local treatment only. Subgroup analysis was also performed in infectious vs non-infectious retinal vasculitis as well as in those who received pan-retinal photocoagulation and anti-VEGF therapy vs. those that did not receive these treatments.
Over 12 years, we had 140 patients coded as retinal vasculitis; 56 male (40%) and 84 female 60%, p=0.0413. The most common diagnosis in our cohort was birdshot chorioretinitis (22%). Overall adjusted mean LogMar visual acuity (VA) at presentation was 0.52 and improved to 0.46 at most recent follow up. For patients receiving IMT (n=54), VA improved from 0.47 to 0.43. In the local group (n=12), vision improved from 0.49 to 0.40. In the prednisone group (n=21), vision worsened from 0.50 to 0.77. There was a trend toward improved VA outcomes for those patients who underwent treatment with PRP/anti-VEGF therapy versus those that did not (p=0.2847).
Our retrospective review is consistent with other studies that show that retinal vasculitis is associated with a wide array of diagnoses. We noted trends toward improvement in VA amongst patients receiving IMT as well as in those who received local treatment only. Interestingly, those who received prednisone treatment only actually showed a trend toward worsening VA from time of presentation. We postulate that patients treated with systemic prednisone had more aggressive disease and thus had worse visual outcomes. Our limitations include the retrospective nature of the study as well as the limitations imposed by chart reviews based on coding data. Retinal vasculitis remains a poorly understood condition and there need to be continued attempts to better evaluate management of this entity.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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