What Is Retinal Vasculitis?

Retinal vasculitis is a large class of inflammatory diseases involving the retinal blood vessels. It is typically manifested by changes in the fundus gray-white vascular sheath, exudation, bleeding, retinal edema, etc., which only invades arteries or veins. Most are affected by both. Eye or systemic diseases often accompanied by retinal vasculitis include: intermediate uveitis, viral retinitis, systemic lupus erythematosus, multiple arteritis, and sarcoidosis.

Basic Information

nickname

Retinal perivascular inflammation

English name

retinal perivasculitis

Visiting department

Ophthalmology

Common locations

Retinal vessels

Common causes

Immune complex deposition, cellular immune response

Common symptoms

Retinal hemorrhage, edema, exudation, telangiectasia, retinal necrosis and hemorrhage, blurred vision, deformed vision, dark shadows in front of eyes, etc.

Causes of retinal vasculitis

Immune complex

Immune complex deposition is an important mechanism for the occurrence of a variety of retinal vasculitis. It has been found to play a role in the occurrence of systemic lupus erythematosus and nodular polyarteritis. But in most cases, the deposition of immune complexes is not specific to retinal blood vessels.

2. Cellular immune response

Studies have found that delayed allergic reactions play an important role in the occurrence of some retinal vasculitis. Activated CD4 ⁺ cells, CD8 ⁺ cells, and macrophages can release some cytokines and cause a series of reactions leading to vascular damage and inflammatory responses.

Retinal vasculitis clinical manifestations

Retinal vasculitis can be divided into 3 types: arteritis, phlebitis, and capillaritis:

Retinal phlebitis and perivenous inflammation

Retinal phlebitis and retinal phlebitis are common types of retinal vasculitis. It is mainly manifested clinically as a vascular sheath surrounding a blood vessel or an inner liner lining the inner wall of a venous blood vessel. Any retinal vein from the optic disc to the peripheral retina can be affected, either in segments or throughout the process. If the inflammation persists, secondary changes such as hyaline degeneration of the blood vessels, narrowing or occlusion of the lumen, thrombosis, necrosis or even rupture of the blood vessel wall can lead to retinal hemorrhage, edema, exudation, capillary dilatation, arterioles Tumor retinal neovascularization and other changes. Such as retinal vascular bleeding or neovascular bleeding, can lead to proliferative vitreoretinopathy, traction of proliferative lesions can lead to retinal detachment.

2. Retinal arteritis

The manifestations of retinal arteritis vary widely clinically. Immune complexes are deposited in the anterior arterioles of capillaries, causing microinfarction, and the appearance of cotton wool spots can be seen in systemic lupus erythematosus, dermatomyositis, and retinal arteritis caused by some infectious factors. Inflammation of the arteriolar branch can manifest as nodular white spots around the vascular cavity, but not beyond the arterial wall. This type is found in toxoplasmosis, syphilis, tuberculosis, herpes zoster virus retinopathy, and this type of plaque The change subsides slowly, leaving no traces or slight scarring. Arteritis can cause irregular white sheaths in the arteries, which can be segmental or full course. Severe arteritis can completely interrupt blood flow in the blood vessel causing large retinal necrosis and hemorrhage. Such severe retinal arteritis can be seen in nodular arteritis, Wegner's granulomatosis, Churg-Strauss syndrome, giant cell arteritis, Takayasu Disease, herpes simplex virus and shingles virus caused by retinitis or acute retinal necrosis syndrome.

3. Retinal capillaritis

Patients often have symptoms such as blurred vision, deformed vision, and dark shadows in front of the eyes. The vision loss is generally not obvious, but when the macular is affected, there may be a significant vision loss. The patient's retina had no obvious bleeding and exudation, vascular sheath, neovascularization, etc., but the patient may have mild retinal edema, macular cystoid edema, and prolonged chronic inflammation patients may also have proliferative changes. Fundus fluorescein angiography revealed extensive retinal microvascular leakage.

Retinal vasculitis examination

Routine inspection

Includes full blood count, erythrocyte sedimentation, and C-reactive protein. Elevated levels of IL-2, soluble IL-2 receptor IL-6, interferon-, and tumor necrosis factor in serum often indicate that patients have systemic disease. Intercellular adhesion molecule-1 (ICAM-1) and von in serum Increased Willebrand factor levels often indicate that vasculitis is active.

2. Immunology technology

In order to exclude or determine some infectious retinal vasculitis, such as vasculitis caused by herpes simplex virus, human immunodeficiency virus, cytomegalovirus and other infections, enzyme-linked immunosorbent assays, immunofluorescence, Western blot tests and other immunology The technique measures specific antibodies, especially IgM antibodies. The use of polymerase chain reaction (PCR) to amplify the DNA of pathogens is of great help in the diagnosis of infectious retinal vasculitis, but it is necessary to strictly observe the experimental procedures to avoid false positive and false negative results.

3. Other auxiliary inspections

(1) Fluorescent fundus angiography (FFA) can show the leakage of fluorescence and staining of the vessel wall. Vascular filling is slow or not filling, and the vascular filling is segmental. The retina can have no perfusion area, and there are microhemangiomas and microvascular abnormalities in the retina. In severe cases, new blood vessels and vitreous blood can appear. Strong fluorescence in the late stage.

(2) Intraocular biopsy Although there are certain restrictions in clinical application, this examination should be considered when infection, malignant tumor and sarcomatoid disease are suspected.

Retinal vasculitis diagnosis

The diagnosis of retinal vasculitis is mainly based on the history of eye manifestations, fluorescein fundus angiography, and certain laboratory tests. Corresponding laboratory and auxiliary tests on some suspicious patients will help determine the specific diagnosis.

Differential diagnosis of retinal vasculitis

Note the difference from acute retinal necrosis syndrome (ARN). Acute retinal necrosis syndrome is a type of necrotizing retinitis caused by herpes zoster virus or herpes simplex virus. It can occur in normal people and in patients with suppressed immune function. It is typically manifested by peripheral progressive, full-thickness necrotizing retinitis, retinal vasculitis, mainly occlusive arteritis, vitreous opacities above moderate severity, and inflammatory responses. Retinal detachment is prone to occur at a later stage.

Retinal vasculitis complications

Retinal vasculitis can cause a variety of complications. The incidence of neovascularization is 10% to 15%. Retinal vasculitis can cause severe retinal ischemia, which can cause iris redness and neovascular glaucoma. Retinal detachment is a rare complication, which is often accompanied by active inflammation and proliferative vitreoretinopathy.

Retinal vasculitis associated with systemic diseases can have corresponding systemic complications. Because retinal vasculitis can occur before systemic disease, these patients are diagnosed as idiopathic retinal vasculitis, so all patients with idiopathic retinitis should pay attention to whether there is a systemic disease in the future.

Retinal vasculitis treatment

For retinal vasculitis, systemic etiology should be searched for and treated. For Eales disease, try glucocorticoids early. Laser photocoagulation of retinal disease vessels and ischemic areas can be used, often multiple times. For persistent vitreous hemorrhage and traction retinal detachment, vitreous surgery and intraocular photocoagulation should be performed. The treatment of retinal vasculitis is mainly decided according to the severity of the patient's vasculitis, the etiology and its complications, and the accompanying systemic diseases. If the patient has only mild retinal vasculitis, without macular cystoid edema and obvious vitreous inflammatory reaction, fluorescein fundus angiography does not reveal severe ischemic lesions. No treatment is required but close observation ; If you find changes in macular cystoid edema, retinal capillaries without perfusion, you should be treated immediately; retinal vasculitis caused by infectious factors, as far as possible, identify pathogenic microorganisms and give specific anti-infective treatment; if determined Patients with retinal vasculitis are related to systemic diseases. In the treatment, they should be considered not only to control retinal vasculitis, but also to control these systemic diseases that may endanger the patient's life or cause serious complications throughout the patient's system. Retinal ischemia and non-perfusion of capillaries often require laser treatment to eliminate avascular areas. If the patient has retinal detachment and vitreous hemorrhage, vitrectomy and other treatments should be performed in the case of drug therapy to control inflammation.

Retinal vasculitis prognosis

The prognosis of retinal vasculitis mainly depends on the etiology and type, the severity of inflammation, whether complications occur, and whether the correct treatment is given. Patients with mild peripheral retinal venous inflammation usually do not need treatment and have a good visual prognosis. However, Behcet's disease often manifests as a recurrent retinal vasculitis and continuous vascular occlusion, with a poor prognosis associated with retinal atrophy and optic nerve atrophy.