This 64YO female presented with 20/30 vision OD and no light perception OS. Her blood pressure was elevated at 147/101, and she had a history of type 2 diabetes. She had a prior macular laser for macular edema.
Although clinically the peripheral retina appeared ischemic, fluorescein angiography showed dramatic, extensive, and total peripheral ischemia OD, with even worse near total loss of retinal perfusion OS. Multiple aneurysmal dilations are seen in the right posterior pole.
We injected both eyes with Avastin that day and applied full panretinal photocoagulation bilaterally over the next 2 weeks. Carotid dopplers showed less than 50% bilateral internal carotid stenosis.
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).
