Investigators of this retrospective study assessed the rates of vision loss and ocular complications in patients with retinal vasculitis (RV).
Study design
The authors reviewed medical records from 96 patients (175 eyes) with RV diagnosed over a 10-year period at the Wilmer Eye Institute.
Outcomes
Over a median follow-up of 44 months (range 1 to 153 months), the rate of vision loss to 20/50 or worse occurred in 40 of 93 eyes, for a rate of 0.13/eye-year (EY). Twenty-eight of these 40 eyes subsequently improved to better than 20/50 vision during the follow-up period.
Vision loss to 20/200 or worse was observed in 26 of 114 eyes, or 0.06/EY. Ten of these 26 eyes later improved to better than 20/200 vision during follow-up.
Most important, patients who received immunosuppressive therapy had a significantly lower risk of vision loss (OR 0.79, P=0.01). Patients with relapsing disease had approximately twice the risk of vision loss, but this finding was not statistically significant due to the small sample size.
Ocular complications of RV included cataract (0.31/EY), epiretinal membrane (0.16/EY) and macula edema (0.09/EY).
Limitations
The study was limited by its retrospective nature, variable follow-up and modest sample size.
Clinical significance
This is a relatively large study involving RV, a rare and potentially sight-threatening condition. Outcomes were, in general, good. The rates of RV-associated vision loss found in this study are similar to those previously reported for noninfectious uveitides such as birdshot chorioretinitis, and better than those for cytomegalovirus retinitis and ocular syphilis.
This study, like others in the field of ocular inflammation, supports the concept that recurrent inflammation is associated with increased visual morbidity. Physicians should strongly consider systemic immunotherapy early in the disease course for patients with chronic and potentially blinding ocular inflammation conditions, with a goal of sustained immunosuppression rather than bursts of corticosteroids with repeated tapers.