Retinal vasculitis


Retinal vasculitis

Description, Causes and Risk Factors:

Retinal vasculitis is an inflammatory disease of the blood vessels of the retina that may be associated with primary ocular conditions or with inflammatory or infectious diseases in other parts of the body (systemic diseases).

Retinal vasculitis can be broadly classified into nonischemic (leaky) and ischemic forms. Ischemic retinal vasculitis is frequently, but not universally, seen in ocular inflammation associated with Behcet's disease and is occasionally seen in sarcoidosis. It can also be a prominent feature of infective retinal disease such as tuberculosis. In contrast, ocular inflammation associated with multiple sclerosis or seronegative arthritis tends to produce vascular leakage only, with retinal ischemia being rare. In the case of idiopathic isolated retinal vasculitis, however, either ischemic or nonischemic disease may occur and the mechanisms favoring the pathogenesis of either type remain unclear. According to Virchow's triad, thrombosis occurs when there are abnormalities within the vessel wall, in the constituents of the blood (thrombophilic factors) or in blood flow, either singly or in combination. We hypothesized that a pre-existing thrombophilia (either genetic or acquired) may be involved in the pathogenesis of idiopathic retinal vasculitis. Examples of these changes are a deficiency of physiological anticoagulants such as Protein C, Protein S or antithrombin III, or an excess of coagulation factors, such as fibrinogen. It has recently been suggested that in Behcet's disease thrombosis occurs only when additional haemostatic abnormalities are present: several patients have been described with congenital Protein S deficiency. Ischemic rather than nonischemic retinal vasculitis may arise as a consequence of one or both of the following: firstly, a higher prevalence of pre-existing thrombophilic factors in ischemic compared with nonischemic retinal vasculitis patients and, secondly, greater retinal vascular endothelial perturbation in the ischemic disease, which causes thrombosis.

von Willebrand's factor (vWF) is the only haemostatic parameter which differentiated ischemic from nonischemic retinal vasculitis, despite all the levels being within the normal range. The higher vWF levels seen in the ischemic retinal vasculitis patients may be the consequence of smoking, or alternatively, may be secondary to endothelial damage brought about by retinal vascular closure.

The most common systemic diseases associated with retinal vasculitis are Beh

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