This 77YO female initially presented with a vitreous hemorrhage, which obscured her fundus. The blood spontaneously cleared, allowing us to see multiple fibrosed arterial macroaneurysms and subretinal lipid.
Fluorescein angiography (FA) shows extensive marked inferotemporal retinal ischemia, scattered capillary dropout, and focal areas of mostly venous staining superiorly and nasally. Panretinal photocoagulation (PRP) was applied to all ischemic areas.
Learning Points:
Idiopathic Retinitis, Vasculitis, Aneurysms, and Neuroretinitis (IRVAN) is a rare disease of unknown etiology characterized by retinal vasculitis, aneurysmal arterial dilations, and neuroretinitis. The diagnosis is clinical, as there are no systemic associations or diagnostic laboratory tests.
Early PRP to areas of widespread retinal nonperfusion is recommended to prevent neovascular complications and vitreous hemorrhage (Samuel et al Ophthalmology 2007;114;1526-1529).
