We report a young female with bilateral retinal vasculitis but with limited findings from 50-degree FA. Ultra-widefield FA played an important role in confirming the diagnosis of idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) and in determining the appropriate treatment.
Interventional case report.
A 26-year-old female complained of progressive blurred vision OD for one week. Her BCVA was 0.6 OD and 1.0 OS. Fundus examination showed bilateral vitreous cells and retinal hemorrhage and vasculitis. FA with 55 degree of view revealed aneurysmal dilations of peripapillary arteriole, peripapillary focal leakage, venous leakage, and capillary nonperfusion area. AF images highlighted aneurysmal dilations of retinal arterioles and vein tortuosity. OCT showed focal disruption in both the ellipsoid and RPE–photoreceptor interdigitation zones. Stage 2 IRVAN was made OU. Oral prednisolone was administered. After four months, she experienced decreased visual acuity OS. OCT revealed subretinal and intraretinal fluid with hyperreflective material. One posterior subtenon triamcinolone and one intravitreal aflibercept injection were performed OS and macular edema subsided. 102 degree ultra-widefield FA showed multiple peripheral background hypofluorescence areas corresponding to capillary nonperfusion. Retinal NV was found OS, which had not been revealed by the previous 55 degree FA. Stage 3 IRVAN was made OS and panretinal laser photocoagulation (PRP) was performed. Oral prednisone and cyclosporine were prescribed. Her vision improved to 1.0 OU.
We use of ultra-widefield FA for detecting peripheral retinal NV and for precise staging. The use of ultra-widefield FA also had direct implications in the follow-up and treatment strategy.