This healthy 63YO male presented with an ill-defined history of blurriness in his right eye upon first waking in the morning. Vision was 20/100 OD and 20/20 in his normal OS. There was diffuse rubeosis OD on slit lamp examination, and intraocular pressure was 28 mmHg.
Optos color RG imaging shows scattered nerve fiber layer infarcts with a rare retinal hemorrhage. Fluorescein angiography shows complete capillary nonperfusion distal to the peripheral macula with late optic nerve leakage. Carotid Doppler and CT angiography were negative.
Intravitreal Avastin was given, followed by full panretinal photocoagulation. He subsequently developed florid rubeosis with neovascular glaucoma requiring an Ahmed tube.
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 panretinal photocoagulation (PRP) to areas of widespread retinal nonperfusion is recommended to prevent neovascular complications and vitreous hemorrhage (Samuel et al Ophthalmology 2007;114:1526-1529).
