Indian Journal of Ophthalmology

BRIEF REPORT
Year
: 2001  |  Volume : 49  |  Issue : 4  |  Page : 269--70

Unilateral frosted branch angiitis with vitreous haemorrhage.


S Agrawal, J Agrawal, TP Agrawal 
 T.P. Agrawal Institute of Ophthalmology, Meerut, Uttar Pradesh, India

Correspondence Address:
S Agrawal
T.P. Agrawal Institute of Ophthalmology, Meerut, Uttar Pradesh
India

Abstract

Idiopathic retinal frosted branch angiitis is a rare bilateral condition and presents with an acute reduction of vision. Unilateral affection is rare. We report an unusual case of unilateral frosted branch angiitis where the patient developed total vitreous haemorrhage.



How to cite this article:
Agrawal S, Agrawal J, Agrawal T P. Unilateral frosted branch angiitis with vitreous haemorrhage. Indian J Ophthalmol 2001;49:269-70


How to cite this URL:
Agrawal S, Agrawal J, Agrawal T P. Unilateral frosted branch angiitis with vitreous haemorrhage. Indian J Ophthalmol [serial online] 2001 [cited 2020 Jan 19 ];49:269-70
Available from: http://www.ijo.in/text.asp?2001/49/4/269/14688


Full Text

Idiopathic retinal frosted branch angiitis is a rare bilateral condition and presents with an acute reduction of vision. Unilateral affection is rare. We report an unusual case of unilateral frosted branch angiitis where the patient developed total vitreous haemorrhage.

Frosted branch angiitis was first described by Ito et al[1] (1976) as an unusually thick sheathing of the veins in a child with idiopathic bilateral retinal periphlebitis. It typically presents with a bilateral, acute, gross reduction of vision. Unilateral frosted branch angiitis is rare.[2,3] Frosted branch angiitis may also be secondary to various causes.[4] There have been two previous reports of frosted branch angiitis in the recent past from India, secondary to rubella and AIDS-associated cytomegalovirus retinitis, respectively.[5], [6] We document a case of this rare entity with total vitreous haemorrhage.

 Case report



A 45-year-old male presented with an acute, grossly diminished vision in the left eye of one day's duration. There was no significant past ocular or systemic history. The right eye had a visual acuity of 6/6 and the ocular examination was unremarkable. The left vision was reduced to counting fingers close to face. There was an afferent pupillary defect. The anterior segment showed no signs of inflammation, and cells were not seen in the vitreous. All the veins of the lower fundus were thickly sheathed, giving rise to frosted branch angiitis. The veins in the upper part had skip lesions and were tortuous and dilated. The optic disc margins were oedematous. Multiple intraretinal and preretinal haemorrhages were present all over the retina. The arteries were partially obscured by the other fundal lesions but appeared normal on gross examination [Figure:1]. Fluorescein angiography showed normal retinal arteriolar filling. There were large areas of hypofluorescence corresponding to the retinal haemorrhages. The pathological retinal veins showed marked staining and late leakage while the venules had delayed emptying. There was late dye leakage from the disc [Figure:2]a, [Figure:2]b. The systemic examination was normal. The patient returned the next day with further diminution of vision. On examination there was total vitreous haemorrhage in the left eye and fundus details were not visible.

The following investigations ordered were all within normal limits: complete blood cell count, erythrocyte sedimentation rate, blood sugar, urine analysis, antinuclear antibody, fluorescent treponemal antibody test, chest x-ray, angiotensin converting enzyme, serum electrolytes, Mantoux test and enzyme-linked immunosorbent assay for tuberculosis, human immunodeficiency virus, cytomegalovirus and herpes zoster and simplex viruses.

The patient was put on oral prednisolone 60 mg/day. Gradually the haemorrhage cleared and vision improved, with the resolution of the disease process, to 6/9 in one month. Prednisolone was slowly tapered by 20 mg at weekly intervals. By one month, the acute inflammation had reduced - sheathing of vessels had decreased and disc oedema had decreased though there were residual scattered retinal and inferior vitreous haemorrhage. Till the last follow-up at 6 months, minimal sclerosis of vessels and inferior dehaemoglobinized blood remained.

 Discussion



It is unclear whether retinal frosted branch angiitis is a distinct clinical syndrome or a clinical sign increasingly recognised in a number of inflammatory conditions.[4] Retinal frosted branch angiitis may occur as a result of viral infections (cytomegalovirus retinitis), autoimmune disease (systemic lupus crythematosus) or infiltration with malignant cells directly (lymphoma or leukaemia) or indirectly as an immune response to viral infections (cytomegalovirus, herpes simplex, herpes zoster, Epstein-Barr virus, rubella, infection).[4] It has also been considered as a severe form of vasculitis/ phlebitis. Hence retinal frosted branch angiitis may be more of a sign than a separate disease.

Retinal frosted branch angiitis may be either primary (idiopathic) or secondary to other systemic diseases. Typically, an idiopathic frosted branch angiitis patient presents with acute, grossly diminished vision in both eyes simultaneously. Thick sheathing of retinal vessels is associated with the presence of multiple intraretinal and preretinal haemorrhages. To our knowledge there are only two reports of unilateral involvement in the literature.[2],[3] Our patient presented with acute idiopathic unilateral frosted branch angiitis and developed total vitreous haemorrhage the following day. This was probably secondary to the acute inflammatory process of the blood vessels. The occurrence of total vitreous haemorrhage in a case of frosted branch angiitis has not been reported earlier. Clinicians should consider retinal frosted branch angiitis as a rare cause of vitreous haemorrhage.

References

1Ito Y, Nakano M, Kyu N, Takeuchi M. Frosted branch angiitis in a child. Jpn J Clin Ophthalmol 1976;30:797-803.
2Sugin SL, Henderly DE, Friedman SM, Jampol LM, Doyle JW. Unilateral frosted branch angiitis. Am J Ophthalmol 1991;111:682-85.
3Seo MS, Woo JM, Jeong SK, Park YG. Recurrent unilateral frosted branch angiitis. Jpn J Ophthalmol 1998;42:56-59.
4Kleiner RC. Frosted branch angiitis: Clinical syndrome or clinical sign? Retina 1997;17:370-1.
5Biswas J, Fogla R, Madhavan HN. Bilateral frosted branch angiitis in an 8-year-old Indian girl. Retina 1996;16:444-45..
6Biswas J, Raizada S, Gopal L, Kumarasamy N, Solomon S. Bilateral frosted branch angitis and cytomegalovirus retinitis in acquired immunodepiciency syndrome. Indian J Ophthalmol 1999;47:195-97.