Frosted branch angiitis

We read with interest the article by Walker et al¹ on frosted branch angiitis review, and would like to draw attention to our paper entitled ‘Unilateral frosted branch angiitis with vitreous haemorrhage’,² a case of an Indian patient, which they missed in referencing. There are very few patients from outside Japan, and this case of ours makes it two patients from India.

There are certain points, which we would want to make, that have not been stressed in the frosted branch angiitis review.¹ It is of note that frosted branch angiitis is usually bilateral and very rarely unilateral, there being very few cases of unilateral frosted branch angiitis.^{2, 3, 4} The uniqueness of our case, besides being the second reported patient of primary frosted branch angiitis from India, was its unilateral nature and development of a dense total vitreous haemorrhage; these patients may present with a vitreous haemorrhage, as happened in our case.²

Also, primary retinal phlebitis/Eales’ disease being very common in India, we have seen about 10 cases of Eales’ disease that at places had frosted branch angiitis-like appearance (Figure 1), again raising the issue whether frosted branch angiitis is a separate disease entity or a clinical sign being increasingly recognized in various inflammatory conditions,⁵ frosted branch angiitis-like clinical picture already having been described in conditions like cytomegalovirus retinitis, etc.^{2, 5} The course of these Eales’ disease cases was similar to that found in frosted branch angiitis patients. No investigations were positive and all responded well to oral corticosteroids. Many patients of Eales’ disease commonly develop neovascularization with intraocular haemorrhaging. This phenomenon, again, is being increasingly recognized in frosted branch angiitis as well.^{6, 7}

Figure 1

A 25-year-old Indian male presenting in the acute inflammatory stage of Eales’ disease. He had blurred vision in right eye of 1 week; the retinal phlebitis gives the appearance of frosted branch angiitis at places. He improved with oral steroids in 1 month. The other eye was lost following neovascularization, vitreous haemorrhage, and tractional retinal detachment from old Eales’ disease.