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

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

3. 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

6. Panretinal photocoagulation IMPROVEMENT
Treatment
Panretinal photocoagulation
IMPROVEMENT

8. 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

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

11. 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

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

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

18. 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