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 Table of Contents  
Year : 2021  |  Volume : 1  |  Issue : 3  |  Page : 611

Commentary: Bilateral occlusive retinal vasculitis in ulcerative colitis

1 Department of Uveitis and Ocular Immunology Services, Narayana Nethralaya, Bangalore, Karnataka, India
2 Department of Cataract and Refractive Surgery Services, Narayana Nethralaya, Bangalore, Karnataka, India

Date of Web Publication02-Jul-2021

Correspondence Address:
Dr. Padmamalini Mahendradas
Department of Uveitis and Ocular Immunology Services, Narayana Nethralaya, Bangalore, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_3801_20

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How to cite this article:
Mahendradas P, Kawali A, Sanjay S, Shetty BK. Commentary: Bilateral occlusive retinal vasculitis in ulcerative colitis. Indian J Ophthalmol Case Rep 2021;1:611

How to cite this URL:
Mahendradas P, Kawali A, Sanjay S, Shetty BK. Commentary: Bilateral occlusive retinal vasculitis in ulcerative colitis. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Jul 26];1:611. Available from: https://www.ijoreports.in/text.asp?2021/1/3/611/320088

We congratulate Chandra K et al. for describing the case report on” Bilateral occlusive retinal vasculitis in ulcerative colitis"[1] Authors highlighted the extraintestinal manifestation presenting in the form of occlusive retinal vasculitis in a case of ulcerative colitis (UC) many years after the initial diagnosis, when the gut is in remission with good clinical outcome. This could be due to many factors. This patient was treated with oral steroids and mesalazine for two years at the time of ulcerative colitis diagnosis. Early initiation of mesalazine within two months has known to reduce the severity of the disease.[2] Authors have highlighted the use of systemic steroids and systemic immunosuppressive therapy to control the eye inflammation with early laser photocoagulation resulted in better outcomes in spite of the systemic disease in remission.[3]

Although the patient is a female, the history of smoking has to be verified in this case because it is well known that smoking exerts a protective effect against both the development and progression of UC.[4] The exact physiopathology of ocular manifestations remains unclear. Lin et al.[5] suggested that a family history of IBD itself may confer an independent, increased susceptibility to the development of ocular inflammation, despite the absence of bowel disease or HLA-B27 positivity.

Episcleritis, the most common ocular extraintestinal manifestation (EIM), seems to be more associated with IBD activity, when compared with other ocular EIMs. Anterior uveitis and dry eyes are other anterior segment manifestations in ulcerative colitis and not related to the intestinal disease activity. Scleritis, intermediate and posterior uveitis are much rarer presentations, occurring in less than 1% of cases, but should be evaluated with caution because, if left untreated, it may progress to permanent visual loss.[6]

Paul S et al. have reported the association between the use of latanoprost eye drops for glaucoma treatment with IBD relapse due to systemic absorption of the drug can cause increase in intestinal inflammation in IBD patients.[7]

A case of retinal vasculitis in UC has been reported in a series published by Felekis et al.[8] Optic neuritis and retinal pigment epithelial detachment was also seen in their there series, they could not exclude the possibility that some of the ophthalmologic complications reported herein may not be related to IBD and may simply represent a coincidental diagnosis unrelated to bowel disease, and the possibility cannot be ruled out completely in the present case.

We reported a single case in a large series of primary retinal vasculitis (RV), who developed UC 16 months after presentation of RV.[9] This was a 41-year-old Asian Indian man with bilateral occlusive retinal vasculitis with neovascularisation elsewhere. After documenting negative baseline uveitic workup, (CBC, ESR, CRP, TPHA, HIV, mantoux, Chest X-ray, Serum ACE, ANA, RBS, Urine microscopy) and after initial systemic steroid therapy patient underwent selective retinal photocoagulation. Then the patient was started on oral azathioprine. Ocular inflammation came under control, but after 16 months of initial presentation the patient was diagnosed as ulcerative colitis and mesalamine 800 mg was added. His repeated fundus fluorescein angiography after 16 months revealed reactivation of retinal vasculitis and hence he was advised to restart systemic steroid therapy and to step up the dose of azathioprine. As reported by Chandra et al., our patient also had almost symmetrical bilateral occlusive RV and responded well to treatment.

  References Top

Chandra K, Singh SR, Singh R, Dogra MR, Dogra M. Bilateral occlusive retinal vasculitis in ulcerative colitis. Indian J Ophthalmol Case Rep 2021;1:310-2.  Back to cited text no. 1
  [Full text]  
Isene R, Bernklev T, Høie O, Munkholm P, Tsianos E, Stockbrügger R, et al; EC-IBD Study Group. Extraintestinal manifestations in Crohn's disease and ulcerative colitis: Results from a prospective, population-based European inception cohort. Scand J Gastroenterol 2015;50:300-5.  Back to cited text no. 2
Vavricka SR, Brun L, Ballabeni P, Pittet V, PrinzVavricka BM, Zeitz J, et al. Frequency and risk factors for extraintestinal manifestations in the Swiss inflammatory bowel disease cohort. Am J Gastroenterol 2011;106:110-9.  Back to cited text no. 3
Roberts H, Rai SN, Pan J, Rao JM, Keskey RC, Kanaan Z, et al. Extraintestinal manifestations of inflammatory bowel disease and the influence of smoking. Digestion 2014;90:122-9.  Back to cited text no. 4
Lin P, Tessler HH, Goldstein DA. Family history of inflammatory bowel disease in patients with idiopathic ocular inflammation. Am J Ophthalmol 2006;141:1097-104.  Back to cited text no. 5
Harbord M, Annese V, Vavricka SR, Allez M, Barreiro-de Acosta M, Boberg KM, et al. The First European Evidence-based Consensus on Extra-intestinal Manifestations in Inflammatory Bowel Disease. J Crohns Colitis 2016;10:239-54.  Back to cited text no. 6
Paul S, Wand M, Emerick GT, Richter JM. The role of latanoprost in an inflammatory bowel disease flare. Gastroenterol Rep (Oxf) 2014;2:232-4.  Back to cited text no. 7
Felekis T, Katsanos K, Kitsanou M, Trakos N, Theopistos V, Christodoulou D, et al. Spectrum and frequency of ophthalmologic manifestations in patients with inflammatory bowel disease: A prospective single-center study. Inflamm Bowel Dis 2009;15:29-34.  Back to cited text no. 8
Kawali A, Bavaharan B, Sanjay S, Mohan A, Mahendradas P, Shetty B. A long-term follow-up of retinal vasculitis-do they develop systemic disease? Ocul Immunol Inflamm. 2020;28:1181-6.  Back to cited text no. 9


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