IRISANGIOGRAPHIC CHANGES IN MULTIFOCAL CHORIORETINITIS
B. Wiechens, B. Nölle
Background: Multifocal chorioretinitis (MFCR) is a chronic inflammatory disease of the peripheral retina and choroid with typical clinical appearance. Accompanying vitritis, cystoid macular edema or complicating cataract can lead to a severe deterioration of visual acuity (V.A.). In spite of systemic corticosteroid treatment and vitreoretinal surgery the visual prognosis is often limited . Although obvious involvement of the anterior segment is often absent or mild, severe chronic inflammatory reactions can occur after cataract surgery. In cases without response to topical or systemic antiinflammatory treatment explantation of an intraocular lens (IOL) or primary aphakia may be necessary . In this study we therefore examined the iris of patients with MFCR by means of fluorescein angiography to investigate anterior segment involvement.
Materials and methods: Ten eyes of 10 patients with MFCR were examined by iris angiography. The average duration of the disease prior to examination was 13 months. All patients had received systemic corticosteroid treatment during the course of the disease. In 6 out of 10 eyes a pars-plana-vitrectomy (PPV) was performed because of marked vitreous opacification. In 3 out of 10 eyes cataract extraction with intraocular lens implantation (IOL) was performed. In 2 out of these 3 eyes the IOL had to be explantated because of therapy refractive chronic inflammatory reaction.
Results: Although clinically unremarkable the iris of all eyes showed marked changes of the vascular system in angiography, such as filling defects, neovascularization with intensive leakage and vascular collaterals. In 2 out of 6 eyes angiographic iris changes regressed after PPV. Conclusion: Irides in patients with MFCR that are unremarkable in slit lamp examination may show marked angiographical changes. Thus iris angiography in those cases with planned cataract extraction and IOL, if necessary combined with PPV for vitreous opacification, may be warranted in order to better assess the prognosis after surgery.
Department of Ophthalmology, Christian-Albrechts-Vniversity Kiel, Hegewischstr. 2, D-24105 Kiel