PERIPHERAL RETINAL VASCULITIS: Analysis of 110 Consecutive Cases and a Contemporary Reappraisal of Tubercular Etiology

Retina. 2017 Jan;37(1):112-117. doi: 10.1097/IAE.0000000000001239.

Abstract

Purpose: Describe the clinical features and outcomes of patients with peripheral retinal vasculitis (RV) and describe clinical characteristics of presumed tubercular RV in a nonendemic setting.

Methods: Retrospective cohort study of 110 consecutive patients with peripheral RV at a tertiary referral eye care center in the United Kingdom. Retinal vasculitis was defined as RV with vitritis associated with peripheral retinal ischemia. Patients who also had positive Quantiferon Gold in Tube test, positive tuberculin skin test, and/or other evidence of systemic tuberculosis such as biopsy were labeled with presumed tubercular RV. Treatment success was defined as resolution of inflammation, and successful tapering of oral corticosteroids to less than 10 mg/day or topical steroids to less than twice a day.

Results: Mean age of the study population was 42.69 ± 14.95 years. Patients were predominantly Asian (49.1%) and Male (67.0%). A total of 73.2% had bilateral involvement. Sixty-nine (62.72%) patients had presumed tubercular RV. A total of 52.8% patients received antitubercular therapy, 65.5% received oral corticosteroids, and 17.3% required steroid-sparing oral immunosuppressive agents. A total of 85.19% of patients with presumed tubercular RV achieved treatment success with concurrent antitubercular therapy as against 75.61% of patients with nontubercular RV.

Conclusion: This is the largest study of the epidemiology, clinical features, and outcomes of both peripheral RV and presumed tubercular RV to date. Presumed tubercular RV commonly seems to affect young males of Asian descent and had vitreous hemorrhage as common clinical findings and also demonstrated a good treatment outcome with antitubercular therapy.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use*
  • Adult
  • Antitubercular Agents / therapeutic use
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Male
  • Middle Aged
  • Retinal Vasculitis* / drug therapy
  • Retinal Vasculitis* / epidemiology
  • Retinal Vasculitis* / etiology
  • Retinal Vasculitis* / pathology
  • Retrospective Studies
  • Steroids / therapeutic use*
  • Tuberculosis, Ocular / complications*
  • Tuberculosis, Ocular / drug therapy
  • United Kingdom / epidemiology
  • Visual Acuity
  • Young Adult

Substances

  • Adrenal Cortex Hormones
  • Antitubercular Agents
  • Immunosuppressive Agents
  • Steroids