Spontaneous Resolution of Macular Exudation with Good Visual Recovery in Idiopathic Retinal Vasculitis, Aneurysms, and Neuroretinitis (IRVAN): A Case Report

Abstract

A 14-year-old boy presented with decreased visual acuity in both eyes of three-months duration. Fundus examination revealed macular exudation in both eyes with aneurysmal changes at the arteriolar bifurcations. Fluorescein angiography confirmed the presence of numerous aneurysmal dilatations of the retinal arterioles and extensive peripheral capillary nonperfusion areas. A provisional diagnosis of idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) was made. Scatter photocoagulation was advised in view of the extensive capillary nonperfusion areas. The patient was then lost to follow-up. He presented a year later with bilateral nonresolving vitreous hemorrhage, more severe in the right eye. He underwent right pars plana vitrectomy. Intraoperatively, the fundus features were similar to those at the initial presentation, but with the absence of any macular exudation. IRVAN represents an evolving clinical condition, with ill-defined clinical aspects, particularly with respect to management. In view of the spontaneous absorption of the macular exudates, we would like to suggest a cautious approach to applying photocoagulation of the retinal aneurysms.