The fluorescein angiographic photodiagnosis of idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome: Outcome of combined therapy.

Abstract

Idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) syndrome is a disease characterized by multiple retinal macroanurysms, neuroretinitis and ischemia in peripheral vessels, which are difficult to diagnose and cause visual loss if delayed. It consists of 5 stages and causes irreversible vision loss with severe complications after stage 2. In this report, photodiagnosis and combined treatment are defined in a Turkish patient with IRVAN syndrome during 6 months of follow-up. Fundus fluorescein angiography (FFA) showed that bilateral aneurysms in retinal vessels as well as aneurysms and ischemic regions were observed in the inferotemporal retina of the left eye. Argon laser photocoagulation was performed to ischemic regions at the left eye. 2 months later best corrected visual acuities were 20/20 and counting fingers from 1 m in the right and left eyes, respectively. Fundus and OCT images showed that an increase in exudations was observed at the left eye and intravitreal injection of dexametasone implant was considered. Three months after initial presentation, best corrected visual acuities were 20/20 and counting fingers from 2 m in right and left eyes, consequetively. In the last fundus and OCT images, the exudations decreased and disappeared on left eye. In this patient, we could not detect an increase in vision due to damage of photoreceptor cells because of subretinal exudation. In the shed-light of this case, the combination therapy seems to improved the anatomical and functional outcomes in IRVAN syndrome however close follow-up and frequent examinations should be prioritized.