Atypical IRVAN presentation Piergiorgio Neri, MB ChB, MD, PhD Head of Ocular Inflammation Unit Ospedali Riuniti di Ancona

Ocular History 43 year old man 5-2006: LE severe visual decrease No systemic problems Tests performed not contributory

May 2006: First presentation BCVA: RE 20/20, LE 20/400 No cells in the anterior chamber, no cell in the vitreous Fundus RE: normal Funsus LE: Retinal vasculitis Multiple macroaneurysms Neuroretinitis

Panretinal photocoagulation IMPROVEMENT Treatment Panretinal photocoagulation IMPROVEMENT

March 2007 BCVA: RE 20/20, LE 20/200 Mild visual disturbances Fundus RE: central retinal vasculits with retinal ischemia Fundus LE: stable after PRP

Treatment Oral prednisone (1mg/Kg/day) associated with mycophenolate mofetil (1g twice/day) IMPROVEMENT

June 2007 BCVA: RE 20/20, LE 20/200 No complaints Fundus RE: microvascular abnormalities with no signs of retinal vasculitis FA in the RE: retinal ischemia in the temporal side Fundus LE: stable after PRP

Treatment Pattern Scan Laser (PASCALTM) Photocoagulation of ischemic areas IMPROVEMENT

Problems Asynchronous occurrence No guidelines for the therapy Pathophysiology (is IRVAN secondary to a vaso-occlusive vasculitis?)

Conclusion IRVAN is generally bilateral, even though the involvement of the eyes is not always synchronous Systemic investigations are generally not contributory It is possible that IRVAN can have a prodromic phase with ischemic retinal vasculitis Systemic steroids and immunesuppression are generally not helpful, but this can be not true, if applied in the prodromic phase Argon laser photocoagulation is mandatory for cases with retinal ischemia