|IMAGES IN RHEUMATOLOGY
|Year : 2019 | Volume
| Issue : 2 | Page : 163-164
Spontaneous complete re-canalization of a retinal vessel following occlusive vasculitis
Brijesh Takkar1, Shorya Azad2, Pradeep Venkatesh2
1 Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
2 Dr. RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
|Date of Web Publication||8-Jul-2019|
Dr. Pradeep Venkatesh
Dr. RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
Keywords: Eye in systemic disease, retinal vasculitis, retinal vein occlusion
|How to cite this article:|
Takkar B, Azad S, Venkatesh P. Spontaneous complete re-canalization of a retinal vessel following occlusive vasculitis. Indian J Rheumatol 2019;14:163-4
A 28-year-old female presented with a complaint of floaters in the right eye. She was undergoing in vitro fertilization procedure. Visual acuity was 6/6 in each eye. Ophthalmoscopy revealed multiple hemorrhages in the retinal area drained by a major retinal vein, distal to an inflamed segment of the vein [[Figure 1]a, arrow indicates phlebitis]. The other eye was normal. Extensive workup done for ascertaining systemic causes of vasculitis in conjunction with the obstetrician did not reveal any finding. Two weeks later, the hemorrhages had increased, and the inflamed segment of vein showed sheathing [[Figure 1]b, arrow indicates affected vein].
|Figure 1: Collage of fundus photographs showing sequential changes in the affected major retinal vessel from Figures (a-d). The white arrow indicates the inflamed retinal vessel. The obstruction first worsens, followed by opening up of compensatory circulation (encircled with inset angiography in Figure c) and finally its spontaneous complete healing|
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The in vitro fertilization failed next month. On re-evaluation of the fundus, the inflammation had subsided, and multiple new tributaries had opened up to drain the affected vein [[Figure 1]c, encircled area]. A fluorescein angiogram done at this stage (avoided previously due to possible pregnancy) confirmed the presence of nonleaking venovenous anastomosis or duplication of the vein [[Figure 1]c, inset picture]. In follow-up, the hemorrhages started decreasing. Spontaneous healing of the retinal vein occurred, and disappearance of collateral vessels was noted by 6 months. After 11 months of presentation, the retinal vein had canalized completely, and there was no clinical sign of previous disease [Figure 1]d.
Conventionally, active retinal vasculitis is treated with steroids in the presence of extensive findings (e.g. >1 retinal quadrant or severe hemorrhages) or due to vision-threatening disease (the presence of macular edema or new vessels). The retinal phlebitis in this case evolved without any intervention. It evolved through stages of worsening followed by subsidence of inflammation, spontaneous compensatory circulation, and finally complete healing of an involved major retinal vessel. She was monitored carefully for the severity of disease and its complications. In either event, careful anti-inflammatory therapy would have been initiated after appropriate consultations. Therefore, clinicians should remember that natural healing of vasculitis may occur, and one should intervene only if indicated. Due to its transparent nature, the eye is indeed a window to the body for a physician. The findings of this case depict the spontaneous compensation that occurs in response to disease.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Azad VS, Takkar B, Venkatesh P. Eye and vasculitis. J Vasc 2016;2:108.