Abstract
The commonest cause of visual morbidity in patients with posterior uveitis is cystoid macular oedema, which usually responds to immunosuppressive treatment. However, a small group of patients do not have a satisfactory visual outcome despite apparently adequate therapy. In a retrospective study of 345 angiograms of 135 patients with active non-occlusive retinal vasculitis 12 patients were identified by independent masked review as showing macular ischaemia on their fluorescein angiograms. Four patients had Behçet's disease, 4 sarcoidosis, and 4 idiopathic retinal vasculitis. Follow-up of these patients for an average of 36 months (range 6-120 months) showed that visual acuity failed to improve in 4 patients and dropped by an average of three lines Snellen in the other 8. We suggest that a poor visual outcome in some patients with posterior uveitis may be predicted by the presence of macular ischaemia on fluorescein angiography and that immunosuppressive therapy should be prescribed with caution in these patients.
Similar content being viewed by others
Article PDF
References
Nussenblatt RB, Palestine AG, Chan CC, Stevens G, Mellow SD, Green SB . Randomised, double-masked study of cyclosporine compared to prednisolone in the treat ment of endogenous uveitis. Am J Ophthalmol 1991; 112:138–46.
Towler HMA, Cliffe AM, Whiting PH, Forrester JV . Low dose cyclosporin A therapy in chronic posterior uveitis. Eye 1989;3:282–7.
Binder AI, Graham EM, Sanders MD, Dinning W, James DG, Denman AM . Cyclosporin A in the treatment of severe Behçet's uveitis. Br J Rheumatol 1987;26:285–91.
Nussenblatt RB, Palestine AG, Chan CC . Cyclosporin A therapy in the treatment of intraocular inflammatory disease resistant to systemic corticosteroids and cytotoxic agents. Am J Ophthalmol 1983;96:275–82.
Benezra D, Cohen E . Treatment and visual prognosis in Behçet's disease. Br J Ophthalmol 1986;70:589–92.
de Vries J, Baarsma GS, Zaal MJW, Boen-Tan TN, Rothova A, Buitenhuis HJ, et al. Cyclosporin in the treatment of severe chronic idiopathic uveitis. Br J Ophthalmol 1990;74:344–9.
Masuda K, Nakajima A, Urayama A, Nakae K, Kogure M, Inaba G . Double-masked trial of cyclosporin versus colchi-cine and long-term open study of cyclosporin in Behçet's disease. Lancet 1989; 1:1093–5.
Muftuoglu AV, Pazarli H, Yurdakul S, Yazici H, Ulku BY, Tuzun Y, et al. Short-term cyclosporin A treatment of Behçet's disease. Br J Ophthalmol 1987;71:387–90.
Yazici H, Pazarli H, Barnes CG, Tuzun Y, Ozyazgan Y, Silman A, et al. A controlled trial of azathioprine in Behçet's syndrome. N Engl J Med 1990;322:281–5.
Nussenblatt RB, Kaufman SC, Palestine AG, Avis MD, Ferris FL . Macular thickening and visual acuity. Ophthalmology 1987;94:1134–9.
Listhaus AD, Freeman WR . Fluorescein angiography in patients with posterior uveitis. Int Ophthalmol Clin 1990;30:297–308.
Finkelstein D . Ischaemic macular oedema. Invest Ophthalmol Vis Sci (ARVO Abstract) 1992;33:805.
Hull RG, Harris EN, Gharavi AE, Tincanig A, Asherson RA, Valesini G, et al. Anticardiolipin antibodies: occurrence in Behçet's syndrome. Ann Rheum Dis 1984;43:746–8.
Hampton KK, Chamberlain MA, Menon DK, Davies JA . Coagulation and fibrinolytic activity in Behçet's disease. Thromb Haemost 1991;66:242–94.
Graham EM, Stanford MR, Sanders MD, Kasp E, Dumonde DC . A point prevalence study of 150 patients with retinal vasculitis. I. Diagnostic value of ophthalmological features. Br J Ophthalmol 1989;73:714–21.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bentley, C., Stanford, M., Shilling, J. et al. Macular ischaemia in posterior uveitis. Eye 7, 411–414 (1993). https://doi.org/10.1038/eye.1993.81
Issue Date:
DOI: https://doi.org/10.1038/eye.1993.81
Keywords
This article is cited by
-
A clinical approach to the diagnosis of retinal vasculitis
International Ophthalmology (2010)
-
Macular ischaemia in Behçet's disease
Eye (2000)
-
Visual outcome of patients with idiopathic ischaemic and non-ischaemic retinal vasculitis
Eye (1996)