TREATMENT OF RETINAL VASCULITIS

Abstract

Retinal vasculitis is an ocular finding that may represent a primary syndrome; may be part of an isolated ocular syndrome, such as birdshot chorioretinopathy; or may be a component of a systemic disease, such as Wegener's granulomatosis or multiple sclerosis. Regardless of the cause of the retinal vasculitis, there are some generalized treatment concepts that should be kept in mind. This article describes the authors' approach to the management of patients with retinal vasculitis. These general guidelines may somewhat vary depending on the underlying cause of the retinal vascular inflammation. As with other forms of uveitis, a stepwise treatment approach is offered. Not all patients with retinal vasculitis require therapeutic intervention. Therapy is probably indicated in a patient exhibiting any of the following symptoms: vision-limiting vitritis, capillary destruction around the foveal avascular zone, broad areas of capillary dropout, or cystoid macular edema. The following methods are discussed: observation, nonsteroidal antiinflammatory preparations, corticosteroids, and immunosuppressive agents. The role of surgical intervention is discussed, as well as some newer innovative approaches to the treatment of ocular inflammation. Certain conditions may vary from these generalized guidelines, and these are discussed later in the article. Before embarking on the use of any immunomodulating therapy, it is imperative for the clinician to have thoroughly evaluated the patient for the possibility of an infectious cause. This should have been done as part of the patient's history and ocular examination, as well as through the use of serologic studies, radiographs, and, if indicated, vitreous humor analysis. Bear in mind that the laboratory evaluation should be carefully guided by the results of a detailed medical history and review of organ systems. If this detailed history is negative then only a limited number of tests should be ordered.8 In most cases the laboratory shotgun approach will be both diagnostically unrewarding and expensive. If a specific infectious agent is identified, then specific antimicrobial therapy is indicated. If no infectious agent is found, then immunomodulating approaches may be indicated.