Retinal arteriolar and venous reperfusion following aggressive treatment for inflammatory occlusive vasculitis

To present a case of dramatic retinal reperfusion in bilateral idiopathic occlusive retinal vasculitis after aggressive treatment with adalimumab, high-dose prednisolone and methotrexate. Retrospective case review A 29-year-old male pilot with bilateral idiopathic occlusive retinal vasculitis developed a worsening right central scotoma while on methotrexate and prednisolone. Fundoscopy and fluorescein angiography (FFA) showed complete occlusion of the right inferotemporal retinal arteriole. High-dose prednisolone was commenced, and adalimumab introduced 4 weeks later. After 12 weeks of this aggressive treatment, repeat multimodal imaging revealed almost complete reperfusion of the previously affected arterial and venous systems. Clinically, the scotoma remained stable. Prompt and aggressive treatment of idiopathic occlusive retinal vasculitis can lead to retinal vascular reperfusion, potentially preventing VEGF-associated complications. However, a degree of visual impairment may remain permanent due to prolonged ischaemia.