Ali Khan Hashim, Ali Khan Qaim, Shahzad Muhammad Aamir, Awan Muhammad Amer, Khan Naeemullah, Jahangir Smaha, Shaheen Fiza, Wali Kamran, Rodman Julie, Pizzimenti Jozeph, Saatci Ali Osman
Department of Ophthalmology, SEHHAT Foundation Hospital, Danyor, Gilgit 15100, Pakistan.
Ophthalmology Department, Agha Khan Health Services, Gilgit, Pakistan.
Ther Adv Ophthalmol. 2022 Jan 21;14:25158414211070880. doi: 10.1177/25158414211070880. eCollection 2022 Jan-Dec.
Idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome is a rare spectrum of retinal vasculitis, aneurysms, and neuroretinitis affecting young individuals in their third decade. Most of our current knowledge is based on case reports, case series, and a handful of collaborative studies. There is much diversity in treatment approaches and outcomes in the reported literature. We have aggregated published case reports and case series into quantitative and narrative synthesis to draw evidence-based conclusions toward clinical features, atypical and rare findings, systemic associations, disease course, and treatment outcomes. The analysis suggested the disease mostly affects young individuals with a female predilection. Anterior chamber and vitreous inflammation are common than previously believed. The most prevalent pattern of retinal vasculitis in IRVAN eyes is mixed vasculitis, followed by arteritis and phlebitis. Most eyes at the time of presentation have capillary nonperfusion and require treatment. Most eyes retain good visual acuity; however, treatment is required to maintain visual function. Intravitreal antivascular endothelial growth factors administered as an adjunct to retinal laser photocoagulation are more likely to improve visual outcomes. Besides, we have discussed the different hypotheses on the etiopathogenesis of the disease and stronger evidence suggests an inflammatory origin of the disease.
特发性视网膜血管炎、动脉瘤和神经视网膜炎(IRVAN)综合征是一种罕见的视网膜血管炎、动脉瘤和神经视网膜炎,主要影响30岁左右的年轻人。我们目前的大部分知识基于病例报告、病例系列以及少数合作研究。已发表文献中的治疗方法和结果存在很大差异。我们汇总了已发表的病例报告和病例系列,进行定量和叙述性综合分析,以便对临床特征、非典型和罕见发现、全身关联、疾病病程及治疗结果得出基于证据的结论。分析表明,该病主要影响年轻个体,女性更易患病。前房和玻璃体炎症比之前认为的更为常见。IRVAN患者眼中最常见的视网膜血管炎类型是混合性血管炎,其次是动脉炎和静脉炎。大多数患者就诊时存在毛细血管无灌注,需要治疗。大多数患者可保持良好视力;然而,需要进行治疗以维持视功能。玻璃体内注射抗血管内皮生长因子作为视网膜激光光凝的辅助治疗更有可能改善视力结果。此外,我们还讨论了关于该病病因发病机制的不同假说,有力证据表明该病起源于炎症。