FROSTED- BRANCH ANGIITIS: OCTA ANALYSIS
Report Optical Coherence Tomography Angiography (OCTa) late phase clinical aspects of unusual and severe case of Frosted-Branch Angiitis.
Case report based on data of clinical and ancillary exams.
A 42- year old male presented with acute severe visual loss for 12 hours. Past history: Overlapping Lupus and Sjogren's Syndrome. Ophthalmological examination: Visual acuity: OD: count fingers 0,5m and OS count fingers 0,2m. Biomicroscopy OU: anterior chamber reaction 4+/4+. Fundoscopy OU: frosted-branch angiitis; vitreous cells in posterior pole OS. Hypotheses: Frosted-Branch Angiitis- Secondary to LUPUS inflammatory activity exacerbation, or inflammation caused by cytomegalovirus. Management: Ceftriaxone 2g twice/day; Oxacillin 2g 6 times/day; Ganciclovir twice/day, Dexamethasone 4mg 4 times/day, Predfort 2/2 h and Mydriacyl 12/12 h. One week after was noted improvement of patient's visual acuity fundoscopic appereance. Cytomegalovirus retinal infection was ruled out in period management.One month after fluorescein angiography was performed and revealed abscence of diffuse ischemic retinal áreas. Six months after OCTa was performed and revealed: OU: decrease in capillary density and abnormality shape on foveal avascular zone in superficial and deep capillary plexus.
Frosted branch angiitis is a rare disorder of unknown cause. It affects most children or young adults, usually bilaterally. It is a diffuse perivasculitis wich can cause severe visual loss. The cause is Unknown, has been suggested that an immune reaction may be responsible. The are no reports analyzing retinal macular perfusion in a late stage of a resolved Frosted- Branch Angiitis case with OCTa. Ischemic areas have not been identified previously with conventional fluorescein angiography.OCTa represents a non invasive new diagnostic modality; It improves the diagnosis and monitoring of various vascular and inflammatory diseases by imaging vascular networks in a greater detail than ever before.
Frosted branch angiites, OCTA, analysis
CLINICAL RETINA
STATE UNIVERSITY OF CAMPINAS - São Paulo - Brasil
ANDRE LUIS AYRES FONSECA, MAURICIO ABUJAMRA NASCIMENTO