Retinal Vasculitis Associated with Vasoproliferative Tumour and Hyperhomocysteinemia: A Case Series

Case1: reported a 31 year old male with complaints of floaters since 15 days with nil systemic history. Both eye BCVA was 6/6 and anteriror segment was normal. RE fundus was normal. Patient had hyperemic disc, splinter haemorrhage, well circumscribed elevated lesion with tortuous blood vessels over it with surrounding sub retinal exudation and inferior vitreous haemorrhage was noted. Case 2: reported a 22 years male with complaints of gradual painless diminution of vision in right eye for past 7 years. Patient had Hypertension for past 2 months on treatment.Patient had Right eye exotropia of 15 degree with BCVA 6/36 and LE 6/12. He had circumcorneal congestion in both eyes. RE occasional cells and LE cells 2+ with flare 1+. LE fundus showed vitritis 1+, dilated tortuous vessels over the posterior pole,temporal periphery showed pre retinal fibrosis and thick membranes, dilated tortuous feeder vessels with Vaso proliferative tumour was noted in the inferotemporal quadrant and subretinal exudation along vessels were noted. Case 3: reported a case 40 year-old female was diagnosed with LE intermediate uveitis + peripheral mass ITQ near the pars plana with vitritis 1+ with vision LE 6/9 N6 and RE was normal with visual acquity of 6/6 N6. LE showed a yellowish mass raising from a snow bank surrounded by vitreous inflammatory snow balls with tortuous fine retinal vessels within the lesion. In all 3 cases fundus fluorescein angiography showed capillary ferning in all quadrants in late venous phase with hyperfluorescent lesion corresponding to the vascular leakage from the tumour. Serum homocysteine level was found elevated. All other uvea work up blood investigations were normal. Both cases were treated with oral steroids 1mg/kg body weight and showed significant improvement. Therefore measuring the Homocysteine levels may be a valuable investigation to manage and improve the outcome of patients with retinal vasculitis.

Keywords: Retinal Vasculitis; Vasoproliferative Tumour; Hyperhomocysteinemia; Retinal Tumour; Ocular Inflammation.