IRVAN (Idiopathic Retinal Vasculitis, Aneurysms, and Neuroretinitis)
A patient presented to the BPEI Emergency Room with a red painful eye and blurred vision. At the time of presentation she was diagnosed with elevated intraocular pressure in the setting of neovascularization of the optic nerve, iris, and angle consistent with neovascular glaucoma. Although she reported a family history of hyperlipidemia, she denied history of smoking, diabetes, hypertension or other retinovascular disease. A systemic workup was largely negative while further clinical workup that included retinal angiography revealed peripheral retinal ischemia, neovascularization, a hot disc, and retinal arterial aneurysms at arterial bifurcation points in a tied-knot appearance. A diagnosis of IRVAN was made. The patient underwent panretinal photocoagulation and intravitreal injections of bevacizumab. The right eye also underwent a glaucoma draining implant surgery for the management of intractably elevated intraocular pressure. Finally, the patient was started on systemic immunosuppression to manage the intra-ocular inflammation with adalimumab.
Presentation Date: 03/21/2024
Issue Date: 04/05/2024
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