MACULAR ISCHEMIA IN POSTERIOR UVEITIS

The commonest cause of visual morbidity in patients with posterior uve itis is cystoid macular oedema, which usually responds to immunosuppre ssive treatment. However, a small group of patients do not have a sati sfactory visual outcome despite apparently adequate therapy. In a retr ospective study of 345 angiograms of 135 patients with active non-occl usive retinal vasculitis 12 patients were identified by independent ma sked review as showing macular ischaemia on their fluorescein angiogra ms. Four patients had Behcet's disease, 4 sarcoidosis, and 4 idiopathi c retinal vasculitis. Follow-up of these patients for an average of 36 months (range 6-120 months) showed that visual acuity failed to impro ve in 4 patients and dropped by an average of three lines Snellen in t he other 8. We suggest that a poor visual outcome in some patients wit h posterior uveitis may be predicted by the presence of macular ischae mia on fluorescein angiography and that immunosuppressive therapy shou ld be prescribed with caution in these patients.