The Importance of Specific Antibiotic Therapy in the Evolution of Retinal Vasculitis

Abstract

Ischemic retinal vasculitis is an inflammation of retinal blood vessels associated with vascular occlusion and retinal hypoperfusion. It may cause visual loss secondary to macular ischaemia, macular edema and neovascularization leading to vitreous hemorrhage, fibroblastic proliferation and retinal detachment by traction. Corticosteroids with or without immunosuppressive medication are the main treatment in retinal vasculitis associated with laser photocoagulation of retinal ischemic regions. In Lyme�s disease, etiologic treatment is achieved with Ceftriaxone that can be associated in some cases with corticosteroids. In this paper, we report about a patient who presented for the decrease of about 1.5 months of painless, asymptomatic visual acuity (VA). The patient was diagnosed with oclusive retinal vasculitis and followed a series of investigations to identify the etiology. The presence of anti-borelial antibodies required the administration of specific treatment with ceftriaxone 1g / 12h to which was added after 48h systemic corticosteroids, with slow evolution favourable. This association of retinal vasculitis - Lyme was quite rare and difficult to demonstrate. The prognosis of patients with retinal vasculitis is variable. Many patients may have a relatively benign condition or may have a dramatic response to systemic imunosuppressive therapy and will retain visual function. In the long run, despite specific treatment, it is unfavorable due to the evolution of retinal atrophy with visual field and visual function. Patients with ischemic retinal vasculitis represent a significant management challenge and, if not treated properly, can lead to a severe, irreversible visual loss.