|Year : 1966 | Volume
| Issue : 5 | Page : 229-231
IS Jain, Kapalmit Singh
Department of Ophthalmology, Institute of Post Graduate Medical Education and Research, Chandigarh, India
|Date of Web Publication||17-Jan-2008|
I S Jain
Department of Ophthalmology, Institute of Post Graduate Medical Education and Research, Chandigarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jain I S, Singh K. Segmental arteritis. Indian J Ophthalmol 1966;14:229-31
Segmental arteritis is a rare condition in which discrete yellowish white exudates are placed along the retinal arteries like beads spaced on a string. The arterial lesion is usually associated with a patch of acute choroiditis. It was first described by Kyrieleis (1933), later Muncaster and Allen (1939) added another case. Third case was added to the list by Thompson in (1952). Giffin and Bodian (19591 described three cases and added the term "Segmental" to the already used term of 'retinal periarteritis! We have preferred to call it 'arteritis' rather than "Periarteritis" because of the absence of sheathing of the arteries. Blach (1960) added three more cases to this list. Because of the rarity of the condition and being the first report from India, the following case merits reporting.
| Case History|| |
H. S. Male, 41 years old, got redness, mild pain, and watering in left eye on 10th Dec., 1965. He was labelled as a case of uveitis and was put on prednisolone. The eye was having hazy media, there was aqueous flare and fine K.P.'s the tension was normal. The fundus could be seen and was reported as normal. Vision was 6/12 P. The eye became quiet in due course of time, but on 6th Jan., 1966 there was again blurring of vision. The vision was 6/12, there was vitreous haze and fine yellowish white beads were found to be present in relation with first division of arteries. In addition just below the disc, about 1½ disc diameter away a patch of choroiditis was noted.
The condition gradually subsided. On 17-2-1966 he again got an attack and at this time all the arterial branches even upto testiary level were involved. In three weeks time this cleared from two vessels, but on 1st March again all the vessels were involved. He got four attacks till 18 July, 1966, when a fresh patch of choroiditis was noted above the previous healed one and was contiguous with it. At this time antitubercular therapy was started. The eye became quiet subsequently but on the 21st October, 1966. a linear hemorrhages was noted above the patch of choroiditis. The 'beads' are still persisting arteries are narrow with wide reflex (almost sclerosed) [Figure - 1],[Figure - 2]. It appears as if knots are given to a white silken thread. The whole of the arterial tree is involved. The field charting revealed a negative scotoma corresponding to the patch of choroditis.
| Investigations|| |
[Table - 1]
Medical check up was done many times but nothing positive was found.
| Comments|| |
"Segmental arteritis", is quite a rare condition. From the literature one finds that it is always associated with a patch of choroiditis. The condition, however, regresses with the regression of choroditis (Griffin and Bodian) or the beads remain as white dots on healing (Blach) as found in the present case. We agree with Blach that it is difficult to hazard a guess whether these beads on the vessels are exudates or inflammatory foci in relation to artery. From the study of the final picture of vessels that emerges it is quite convincing that probably both the factors are playing a role.
The arteries in our case were uniformly narrow and sclerosed. There was no sheathing of the arteries. It is neither possible to explain it merely on the basis of involvement of vessels segmentally, nor it is possible to explain it on the basis of deposition of exudates from vitreous. The explanation put forward by Griffin and Bodian that the plaques on the vessels possibly represent migration of exudates from the active choroiditis patch to the periarterial sheaths does not seem feasible, because of the obvious querry that why it should be segmental and why veins arc not involved.
The nature and production of beads still remains in the realm of speculation, till such time when pathological material is available. It appears as if there is basically a generalised arteritis associated with choroidits patch. The arterial lesion appeared about 26 days after the attack of uveitis. It is possible that it might be a sensitization phenomenon. Considering the etiology of the condition, the older literature described it as a tuberculous infection while Griffin and Bodian (1959) casted doubt on such conclusion. They based their belief on the observation that in his case, there is no frank tuberculous infection: tuberculin test was negative or inconclusive and thirdly that the lesions responded to corticosteroids. Blach (1960) however, treated all his cases on sanitorium regimen. The first and third points, do not seriously go against any tuberculous hypothesis, as long as we know that it is tuberculoprotein allergy which is a basic factor involved in the process. Our case lends support to the tuberculous hypothesis by the fact that Montoux was strongly +ve. 1: 1,000 and that the fresh choroiditis patch which appeared later was at the margin of the previous one. Such a contiguity of satellite lesion is considered characteristic of tuberculous lesion, by many workers.
| Summary|| |
A case of segmental arteritis is reported. The probable aetiological factors are discussed.
| References|| |
Kyrieleis, W. (1933): Arch. of Augenh. 107: 182. Ref. by Griffin and Bodian A.J.O. 47, 544.
Griffin. A. O.; Bodian, M. (1959) A.J.O.: 47, 544.
Blach R. K., (1960) B. J. O. 44, 562.
Thompson, A. M. (1952) B.J.O. 37, 268.
Muncaster, S. B.: Aliens H. E. (1939) Arch. of Ophth. 21: 509.
[Figure - 1], [Figure - 2]
[Table - 1]