Unilateral Frosted Branch Angiitis Treated with Intravitreal Dexamethasone Implant
International Journal of Ophthalmology & Visual Science
Volume 5, Issue 3, September 2020, Pages: 75-79
Received: Jul. 17, 2020; Accepted: Aug. 24, 2020; Published: Sep. 24, 2020
Views 58      Downloads 25
Authors
Nishikant Borse, Insight Eye Clinic, Mumbai, India
Veena Borse, Insight Eye Clinic, Mumbai, India
Article Tools
Follow on us
Abstract
Frosted branch angiitis (FBA), a relatively rare condition, is a retinal perivasculitis with severe retinal vessel sheathing resembling the frosted branches of a tree. It can be a Primary Idiopathic FBA or Secondary FBA when associated with systemic conditions like viral infections, sarcoid etc. Primary frosted branch angiitis causes characteristic florid, translucent retinal perivascular sheathing of both arterioles and venules in association with variable uveitis, retinal edema and visual loss. Additional retinal findings may include intraretinal haemorrhages, hard exudates, and serous exudative detachments of the macula and periphery. 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. Hence, retinal frosted branch angiitis may be more of a sign than a separate disease. Treatment is usually with corticosteroids and normally leads to a good visual recovery. We report a case of primary unilateral frosted branch angiitis with large areas of capillary drop out and severe macular edema. It was successfully managed with intravitreal injection of Dexamethasone Implant (Ozurdex TM) in conjunction with a very short course of systemic steroids. To our knowledge, this is the first documented case of primary unilateral FBA treated with systemic steroids and an intravitreal dexamethasone implant.
Keywords
Frosted Branch Angiitis, Unilateral, Dexamethasone Implant
To cite this article
Nishikant Borse, Veena Borse, Unilateral Frosted Branch Angiitis Treated with Intravitreal Dexamethasone Implant, International Journal of Ophthalmology & Visual Science. Vol. 5, No. 3, 2020, pp. 75-79. doi: 10.11648/j.ijovs.20200503.12
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
[1]
Sandhu RK, Adams T, Sibley C, et al. Granulomatosis with polyangiitis (Gap) presenting with frosted branch angiitis. Retina Cases Brief Rep 2016; 10: 249-51.
[2]
Walker S, Iguchi A, Jones NP. Frosted branch angiitis: a re¬view. Eye (Lond) 2004; 18: 527-33.
[3]
Kleiner RC. Frosted branch angiitis: clinical syndrome or clinical sign? Retina 1997; 17: 370.
[4]
Sugin SL, Henderly DE, Friedman SM, Jampol LM, Doyle JW. Unilateral frosted branch angiitis. Am J Ophthalmol 1991; 111: 682-85.
[5]
Seo MS, Woo JM, Jeong SK, Park YG. Recurrent unilateral frosted branch angiitis. Jpn J Ophthalmol 1998; 42: 56-59.
[6]
Agrawal S, Agrawal J, Agrawal T P. Unilateral frosted branch angiitis with vitreous haemorrhage. Indian J Ophthalmol2001; 49: 269-70.
[7]
Ito Y, Nakano M, Kyu N, Takeuchi M. Frosted branch angiitis in a child. Jpn J Clin Ophthalmol 1976; 30: 797-803.
[8]
Hernandez-Da Mota SE, Arellanes-Garcia L, Recillas-Gispert C et al (2011) Lupus relapse presented as frosted branch retinal angiitis: case report. Ocul Immunol Inflamm 19: 367–369.
[9]
Quillen DA, Stathopoulos NA, Blankenship GW, Ferriss JA (1997) Lupus associated frosted branch periphlebitis and exudative maculopathy. Retina 17: 449–451.
[10]
Kwon SJ, Park DH, Shin JP (2013) Frosted branch angiitis as ocular manifestation of Behcet’s disease: unusual case report and literature review. Korean J Ophthalmol 27: 466–469. doi: 10.3341/kjo.2013.27.6.466.
[11]
Sykes SO, Horton JC (1997) Steroid-responsive retinal vasculitis with a frosted branch appearance in Crohns disease. Retina 17: 451–454.
[12]
Spaide RF, Vitale AT, Toth IR, Oliver JM (1992) Frosted branch angiitis associated with cytomegalovirus retinitis. Am J Ophthalmol 113: 522–528.
[13]
Markomichelakis NN, Barampouti F, Zafirakis P et al (1999) Retinal vasculitis with a frosted branch angiitis-like response due to herpes simplex virus type 2. Retina 19: 455–45.
[14]
Zhao H, Guan J, Zhou L et al (2012) Frosted branch angiitis in a woman with Mycobacterium tuberculosis infection. Ocul Immunol Inflamm 20: 227–229. doi: 10.3109/09273948.2012.673044
[15]
Suzuki T, Onouchi H, Nakagawa Y et al (2010) A case of recurrence of congenital ocular toxoplasmosis with frosted branch angiitis (ocular toxoplasmosis with frosted branch angiitis). Tokai J Exp Clin Med 35: 122–125.
[16]
Walker S, Iguchi A, Jones NP (2004) Frosted branch angiitis: a review. Eye18: 527–533. doi: 10.1038/sj.eye.6700712
[17]
Matsui Y, Tsukitome H, Uchiyama E et al (2013) Peripheral capillary nonperfusion and full field electroretinographic changes in eyes with frosted branch-like appearance retinal vasculitis. Clin Ophthalmol 7: 137–140. doi: 10.2147/OPTH.S40110
[18]
Kim TS, Duker JS, Hedges TR (1994) Retinal angiopathy resembling unilateral frosted branch angiitis in a patient with relapsing acute lymphoblastic leukaemia. Am J Ophthalmol 117: 806–808.
[19]
Hua MT, Blaise P, De Leval L, Rakic JM (2009) Frosted branch angiitis with undiagnosed Hodgkin lymphoma. Eur J Ophthalmol 19: 310–313.
[20]
Wong R, Cunningham E (2013) Posterior segment findings in SLE. Rev Ophthalmol 20: 41–45.
[21]
Wood and Wong Journal of Ophthalmic Inflammation and Infection (2016) 6: 20 DOI 10.1186/s12348-016-0089-9.
[22]
Frosted Branch Angiitis: Elisabetta Miserocchi, M. D. Available at: http://www.uveitis.org/docs/dm/frosted_branch_angiitis.pdf.
[23]
Robinson MR, Whitcup SM. Pharmacologic and clinical profile of dexamethasone intravitreal implant. Expert Rev Clin Pharmacol. 2012; 5: 629–47. (PubMed) (Google Scholar).
[24]
Haller JA, Bandello F, Belfort R, Jr, Blumenkranz MS, Gillies M, Heier J, et al. Randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion. Ophthalmology. 2010; 117: 1134–46.e3. (PubMed) (Google Scholar).
[25]
Haller JA, Bandello F, Belfort R, Jr, Blumenkranz MS, Gillies M, Heier J, et al. Dexamethasone intravitreal implant in patients with macular edema related to branch or central retinal vein occlusion twelve-month study results. Ophthalmology. 2011; 118: 2453–60. (PubMed) (Google Scholar).
[26]
Lowder C, Belfort R, Jr, Lightman S, Foster CS, Robinson MR, Schiffman RM, et al. Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis. Arch Ophthalmol. 2011; 129: 545–53. (PubMed) (Google Scholar).
[27]
Karim R, Sykakis E, Lightman S, Fraser-Bell S. Interventions for the treatment of uveitic macular edema: A systematic review and meta-analysis. Clin Ophthalmol. 2013; 7: 1109–44. (PMC free article) (PubMed) (Google Scholar).
[28]
Dong Yoon Kim, Jinho Jeong & Jin Young Kim; Frosted Branch Angiitis Secondary to Granulomatosis with Polyangiitis Korean J Ophthalmol. 2019 Oct; 33 (5): 485–486.
ADDRESS
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
U.S.A.
Tel: (001)347-983-5186