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LETTER TO EDITOR
Year : 2021  |  Volume : 8  |  Issue : 1  |  Page : 36-37

Frosted branch angiitis with CRAO in cytomegalovirus retinitis


1 Vitreo-Retinal Surgeon, Sarakshi Netralaya, Nagpur, Maharashtra, India
2 Optometrist, Sarakshi Netralaya, Nagpur, Maharashtra, India

Date of Submission01-Feb-2021
Date of Acceptance08-Oct-2021
Date of Web Publication27-Jan-2022

Correspondence Address:
Dr. Shilpi Harshal Narnaware
Sarakshi Netralaya, 19, Rajiv Nagar, Wardha Road, Nagpur - 440 025 Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/erj.erj_1_21

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How to cite this article:
Narnaware SH, Bawankule PK, Chivane A. Frosted branch angiitis with CRAO in cytomegalovirus retinitis. Egypt Retina J 2021;8:36-7

How to cite this URL:
Narnaware SH, Bawankule PK, Chivane A. Frosted branch angiitis with CRAO in cytomegalovirus retinitis. Egypt Retina J [serial online] 2021 [cited 2022 Aug 14];8:36-7. Available from: https://www.egyptretinaj.com/text.asp?2021/8/1/36/336666



Sir,

A 38-year-old immunocompromised female presented with complaints of diminution of vision in the right eye for the past 7 days with visual acuity of 3/60. Anterior-segment examination revealed quiet anterior chamber. Fundus evaluation showed vitreous haze, phlebitis, few retinal hemorrhages and exudates, suggestive of cytomegalovirus (CMV) retinitis (frosted branch angiitis) [Figure 1]. Optical coherence tomography (OCT) revealed intraretinal exudates and serous macular detachment [Figure 2]. She was given two doses of intravitreal ganciclovir for the same. Three days after second dose of intravitreal ganciclovir, she complaints of further drop in vision to perception of light. Anterior-segment examination was within normal limits. Fundus evaluation showed resolving phlebitis with retinal hemorrhages and exudates (suggestive of resolving retinitis) with cherry red spot at macula, suggestive of secondary Central retinal artery occlusion (CRAO) [Figure 3]. OCT revealed vitreous opacities, intraretinal exudates, serous macular detachment, and increased thickness of inner retinal layers [Figure 4].
Figure 1: Fundus photograph showing perivascular inflammation of both arteries and veins with exudation

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Figure 2: OCT showing intraretinal exudates and serous macular detachment

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Figure 3: Fundus photograph showing cherry red spot at macula with exudation and hemorrhages.

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Figure 4: OCT showing vitreous opacities, intraretinal exudates, serous macular detachment, and inner retinal layers edema

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Frosted branch angiitis can be an idiopathic disorder or can be associated with ocular and systemic diseases. Among ocular associations, CMV retinitis, AIDS retinitis, and toxoplasmic chorioretinitis are the most frequent. The most common ocular symptom is acute visual loss.

Clinical characteristics include anterior-segment inflammation (usually mild). Conversely, the grade of posterior-segment inflammation is always severe. Whole retina is edematous, with the characteristic findings of uninterrupted white and thick sheathing of vessels, which start from the optic disc and extend to the periphery, i.e. widespread periphlebitis. Although both arteries and veins are involved, venules tend to be more commonly affected. Retinal exudates and hemorrhages are also noted. Inflammatory exudates around retinal vessels are thought to be antigen–antibody complexes.[1],[2] Optic disc is frequently edematous and hyperemic.

Although prognosis of this disease is usually good, various complications associated with frosted branch angiitis include capillary non perfusion, neovascular glaucoma, retinal vein occlusion, vitreous hemorrhage, macular epiretinal membrane formation, diffuse retinal fibrosis, retinal tear/retinal detachment, and optic disc atrophy, but its association with CRAO is not reported in the literature.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest



 
  References Top

1.
Kleiner RC, Kaplan HJ, Shakin JL, Yannuzzi LA, Crosswell HH Jr., McLean WC Jr. Acute frosted retinal periphlebitis. Am J Ophthalmol 1988;106:27-34.  Back to cited text no. 1
    
2.
Sugin SL, Henderly DE, Friedman SM, Jampol LM, Doyle JW. Unilateral frosted branch angiitis. Am J Ophthalmol 1991;111:682-5.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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