Abstract
Key Clinical Message
FBA is a clinical diagnosis of a diverse spectrum, which needs a high index of suspicion to identify the possible specific etiologies. The zones of retinal involvement can help in predicting the final visual outcome. The proposed diagnostic algorithm facilitates meticulous evaluation and targeted treatment to improve the final visual outcome.
Abstract
Frosted branch angiitis is a clinical diagnosis of a diverse spectrum, which needs a high index of suspicion to identify the possible specific etiologies. We present a series of three cases of FBA with an attempt to formulate a diagnostic algorithm and refine the definition of FBA.
Keywords: Behcet's, frosted branch angiitis, idiopathic, tuberculosis, uveitis
1. INTRODUCTION
Frosted Branch Angiitis (FBA) is an acute panuveitis with severe vasculitis affecting the entire retina. FBA was first described in 1976 in the Japanese literature by Ito in a 6‐year‐old child presenting with diffuse sheathing of all retinal vessels, producing the appearance of frosted branches of a tree. 1 As then it has been reported from North America, Turkey, Korea, Spain, Japan, and India. As there is a predilection for veins over arteries, it is also called as diffuse acute retinal periphlebitis. 2 It is typically bilateral with a higher male preponderance, although unilaterality (28%) does not rule out this entity. 1 The reported etiological categories of FBA are variegated, inconsistent and include idiopathic, traumatic, infective [cytomegalovirus (CMV), acquired immunodeficiency syndrome (AIDS) and toxoplasma, tuberculosis, familial Mediterranean fever, coagulase‐negative staphylococci, streptococcus, herpes simplex virus (HSV), varicella zoster virus (VZV), Epstein–Barr virus (EBV), influenza type a, mycoplasma pneumoniae], autoimmune [systemic lupus erythematosus, Behcet's, Crohn's disease, antiphospholipid antibody syndrome (APLA), Wegner's granulomatosis, glomerulonephritis], masquerades [large cell lymphoma, acute lymphoblastic leukemia, Hodgkin's lymphoma], and miscellaneous [antithyroid medications, adalimumab, pediatric dyskeratosis congenita]. 3
Although a large number of cases have been documented, the initial published series of FBA are limited by the description of homogenous‐specific etiologies and shorter duration of follow‐up. The initial fundus fluorescein angiogram (FFA) definition of FBA 1 proposed a normal pattern in the first stage, with leakage of the dye from vessels in the later frames with emphasis on the sheathed vessels revealing no signs of occlusion. However, it is challenged by the recent findings of vascular occlusion in FBA, as several occlusive vasculitis like Behcet's disease can manifest with an FBA‐like picture. 4 In addition, the previously published literature documents case reports and review articles on FBA, but none of them have described any case series with zones of involvement along with diagnostic algorithm. In this case series, we analyze the contemporary cases of FBA encompassing its heterogenous‐specific etiologies with appropriate follow‐up duration. We also attempt a plausible algorithm to the clinician for appropriate work‐up and a treatment plan.
2. CASE REPORT
2.1. Case 1
A 47‐year‐old male presented with sudden onset, painless, defective vision in the right eye (RE) for past 3 days. Best corrected visual acuity (BCVA) was finger counting close to the face (FCF). Anterior segment examination revealed 1+ cells, 1+ flare, and relative afferent pupillary defect. Dilated fundoscopy revealed disc edema, telangiectatic vessels, and perivascular sheathing in all quadrants with all three zones of involvement. Optical coherence tomography (OCT) macula revealed a central macular thickness (CMT) of 565 μm. Fundus fluorescein angiography (FFA) depicted disc leakage with diffuse vascular leakage, and capillary non‐perfusion areas throughout the retina. General examination revealed aphthous and genital ulcers. Blood investigations were normal except raised erythrocyte sedimentation rate. Corticosteroids were administered intravenously and periocularly, with the latter being through a posterior subtenon's injection. This was in addition to topical treatment with 1% prednisolone six times/day and 2% homatropine two times/day. A diagnosis of Behcet's disease was made by the rheumatologist. Due to a suboptimal response to steroids, intravenous cyclophosphamide and cyclosporine were commenced. The posttreatment visual acuity was 6/36 till 18 months of last follow‐up (Figures 1, 2 and 3).
FIGURE 1.
(A) Pretreatment fundus image of the right eye of the patient with FBA secondary to Behcet's disease depicting hyperemic disc with blurred disc margins, macular edema with a star, extensive perivascular sheathing with multiple flame‐shaped hemorrhages, and cotton wool spots along the posterior pole with tortuous and dilated blood vessels. There is also a patch of intraretinal hemorrhage inferior to the inferotemporal arcade. (B) Posttreatment fundus montage of the patient's right eye depicting disc pallor with vascular sheathing along arcades and macular star. The nasal half of the retina shows chorioretinal atrophic patches due to laser marks along with intraretinal hemorrhage in all quadrants.
FIGURE 2.
Optical coherence tomography (OCT) image of the macula of the right eye of the same patient hyperreflective irregular retinal layers suggestive of retinal edema with multiple hyperreflective dot echoes along with back shadowing suggestive of exudates and submacular fluid. They are dot echos in the posterior vitreous suggestive of vitreous hemorrhage.
FIGURE 3.
(A) Pretreatment late phase fundus fluorescein angiography (FFA) montage of the right eye of the same patient depicting disc leakage, irregular foveal avascular zone, tortuous blood vessels with vascular leakage and diffuse staining, capillary non‐perfusion areas throughout the retina. There are also multiple hypo fluorescent patches at the posterior pole due to blocked choroidal fluorescence. (B) Posttreatment late phase fundus fluorescein angiography (FFA) montage of the right eye of the same patient depicting reduced disc leakage, mild staining of blood vessels, irregular foveal avascular zone, and blocked choroidal fluorescence.
2.2. Case 2
A 31‐year‐old male presented with sudden onset vision deterioration for four days. BCVA was 5/60 in both eyes (BE). Anterior segment examination revealed 1 + cells. Fundus examination revealed disc edema, retinal edema, active vascular sheathing and subretinal fluid at macula along with Zone 2 and 3 involvement. OCT macula revealed CMT of 456 μm and 470 μm in RE and LE, respectively. FFA displayed mild disc staining with vascular staining and leakage in the superotemporal arcade. Blood investigations were normal. Patient was started on topical prednisolone and homatropine. A comprehensive evaluation done by an internist was inconclusive and the patient was labeled as a case of idiopathic FBA. The final BCVA was 6/6 till 15 months of follow‐up (Figures 4, 5, and 6).
FIGURE 4.
(A, B) Pretreatment fundus montage image of the right eye and left eye of the patient with idiopathic FBA depicting disc edema with hyperemia, and macular edema, tortuous dilated blood vessels, perivenous cuffing, and scattered intraretinal hemorrhages. (C, D) Posttreatment normal fundus image of the right and left eye.
FIGURE 5.
(A, B) Pretreatment optical coherence tomography (OCT) image of the macula of both eyes of the same patient depicting multiple hyperreflective dot echo's in all retinal layers. (C, D) Posttreatment normal OCT of both the eyes.
FIGURE 6.
(A) Pretreatment fundus fluorescein angiography (FFA) image of the right eye of the same patient depicting disc staining with mild vascular staining and leakage along the supero‐temporal arcade. (B) Pretreatment normal FFA image of the left eye of the patient. (C, D) Posttreatment normal FFA image of both eyes of the patient.
2.3. Case 3
A 45‐year‐old female presented with sudden onset defective vision in RE for the past 2 days. The presenting BCVA was 3/60. Anterior segment examination revealed 1 + cells in anterior chamber, and 1+ cells in the anterior vitreous face. Fundus examination showed vitreous membranes, hyperemic disc edema, retinal edema, sheathed vessels, and few choroidal folds with all three zones of involvement. OCT macula revealed a CMT of 440 μm. FFA showed disc staining, mild vascular staining along with leakage. Patient was started on topical 1% prednisolone drops four times/day. Blood investigations were normal, except for a positive Mantoux with 15 mm induration. Patient was referred to an internist, where chest x‐ray imaging revealed bilateral hilar lymphadenopathy, and quantitative polymerase chain reaction of vitreous was positive for mycobacterium tuberculosis antigens MPB64. Patient was started on antitubercular therapy (ATT) and oral steroids. The final visual acuity improved to 6/36 till 12 months of last follow‐up (Figure 7). A summary of all three cases in listed in Table 1.
FIGURE 7.
Fundus image of the patient with tubercular etiology depicting severe sheathing of retinal vessels along with macular edema.
TABLE 1.
Clinical profile of various etiologies of frosted branch angiitis.
Case No | Etiology age | Eye | Visual acuity (V.A.) | Anterior segment findings | Fundoscopy | Key investigations and management | Diagnostic clues | Zones of involvement 12 | Follow‐up, response, and final VA |
---|---|---|---|---|---|---|---|---|---|
1 | Behcet's 47 years | RE | FCF | 1+ cells, flare, Relative afferent pupillary defect | Perivascular sheathing, telangiectatic vessels, disc edema (Figure 1) |
Blood investigations‐ normal, raised ESR OCT macula‐ CMT 565 um FFA‐ Image 3a and 3b steroids, cycloplegics, cyclophosphamide and cyclosporine |
Aphthous and genital ulcers, diagnosed by rheumatologist. Had suboptimal response to steroids alone and improved with cyclosporine | 1,2,3 | 18 months, improved with immuno suppressants Posttreatment visual acuity 6/36 |
2 | Tuberculosis 45 years | RE | 3/60 | Normal |
1+ Anterior vitreous phase (AVF) cells, Vitreous membranes, Sheathed vessels, few choroidal folds, and retinal edema |
OCT macula‐CMT 440 um FFA‐Perivascular leakage with disc leakage Anti‐tubercular therapy (ATT) and oral steroids in tapering doses |
Mantoux‐15 mm induration, Chest imaging showed bilateral hilar lymphadenopathy, Qualitative polymerase chain reaction (PCR) of vitreous was positive for mycobacterium tuberculosis antigens [MPB64, IS6110] Poor response to oral steroids alone, Prompt response to ATT + oral steroids |
1,2,3 | 12 months, improved with ATT and steroids, posttreatment visual acuity 6/36 |
3 | Idiopathic 31 years | BE | 5/60 | 1+ cells | Active vascular sheathing, retinal edema, subretinal fluid at macula (Figure 2) |
Blood investigations‐normal OCT macula‐CMT‐456 um O.D. and 470um OS FFA‐Image 6a and 6b steroids and cycloplegics |
Color vision defect present, Visual fields show peripheral constriction |
2, 3 | 15 Months, improved with steroids, posttreatment visual acuity 6/6 |
3. DISCUSSION
FBA is a descriptive term for a unique type of posterior uveitis and widespread retinal vasculitis. 1 The florid translucent perivascular exudate inspired the descriptive term “Frosted Branch Angiitis.” 3 FBA predominantly affects the young and healthy. The youngest patient reported to date was 2 years and the oldest 48 years. The most common presenting symptoms include subacute visual loss, floaters, and photopsia. Visual acuity can be substantially reduced to the extent of perception of light. 5 Most patients (75%) have bilateral affliction. There have been few reports of FBA from India in the recent past, where the etiology or association has been idiopathic, trauma, cytomegalovirus (CMV), AIDS, tuberculosis, glomerulonephritis, typhoid fever, sympathetic ophthalmia, endophthalmitis, central retinal vein occlusion, vitreous hemorrhage, and pregnancy. The specific diagnostic criterion were used for tuberculosis 6 and Behcet's disease. 7 Table 2 outlines a comprehensive comparative analysis of the published cases in the literature. 8 , 9 , 10 , 11 , 12 , 13
TABLE 2.
Modified Kleiner's classification.
S. No | Group | Category | Pathology |
---|---|---|---|
1 | Group 1 | Masquerade |
Lymphoma Leukemia |
2 | Group2 | Autoimmune |
Systemic lupus erythematosus. Chron's disease, Anti‐phospholipid antibody syndrome. |
Non‐Infectious | Sarcoidosis, multiple sclerosis, Behcet's disease. | ||
Infectious | Cytomegalovirus, herpes simplex virus, herpes zoster virus, Epstein–Bar virus, tuberculosis, toxoplasmosis, syphilis, mycoplasma, rubella. | ||
3 | Group 3 | Primary | Idiopathic |
Kleiner et al. 2 classified FBA into three distinct subgroups (Table 2 and Figure 8). The pathogenesis of FBA can be broadly categorized as idiopathic and non‐idiopathic. The former encompasses those cases where the etiology largely remains unknown. The prompt response to steroids in such cases also suggests a probable immune‐mediated mechanism. Non‐idiopathic includes those patients with associated viral diseases (EBV, Rubella, CMV, AIDS), where it has been postulated that viral antigens form immune complexes and deposit in retinal vessels causing vasculitis. A direct viral injury to endothelial cells (CMV has a particular tropism for endothelial cells) has also been held responsible for the pathogenesis.
FIGURE 8.
Image depicting Kleiner's classification.
The treatment of FBA in the immunocompetent group includes corticosteroid after excluding the treatable specific causes. In non‐resolving cases, long‐term immunosuppression and additional use of biologicals can be beneficial to prevent recurrence. 14 The prognosis in FBA is usually good. Although complications are rare, they include neovascular glaucoma, macular scarring, retinal detachments, and vitreous hemorrhage in untreated cases.
The first case with Behcet's disease had profoundly low BCVA of FCF at presentation. The patient showed a prompt response to cyclosporine, eventually attaining a BCVA of 6/36 at 18 months of follow‐up. Kwon et al. 15 reported a case of a 39‐year‐old male with unilateral FBA associated with Behcet's disease treated with systemic steroids and cyclosporine. They showed that early initiation of cyclosporine is crucial in treating FBA secondary to Behcet's disease. Our case is consistent with the same.
The second patient was diagnosed with idiopathic FBA having a BCVA of 5/60 in BE. The patient showed a good response with steroids with a final BCVA of 6/6. Consistent with our case, a good response with steroids was reported by Maleki et al. 16 in a case of idiopathic bilateral FBA in a 5‐year‐old child with a BCVA of hand motion in BE. Fundus examination revealed prominent and florid retinal perivascular infiltration with predominant affliction of venules, initiating from the posterior pole and extending up till the periphery. The child showed resolution with empirical treatment using oral prednisolone (1 mg/kg/day) and topical corticosteroids resulting in a final BCVA of 6/20 in BE.
The last patient with tuberculosis presented with a BCVA of 3/60 in LE. Due to a history of contact with tuberculosis and poor response to oral steroids initiated elsewhere, PCR for MPB 64 primer was contemplated and was conclusive of tuberculosis. The patient showed a good therapeutic response with ATT and steroids with a final BCVA of 6/36. Zhao et al. 6 reported a case of a 27‐year‐old woman of tuberculous meningitis with sheathing of the retinal venules and arterioles, consistent with FBA in BE. After treatment with ATT and steroids, FBA resolved. In endemic countries, the clinical clue to tuberculosis could arise from poor response to oral steroids, a positive response to the addition of ATT, and consistent PCR reports.
FBA may affect any part of the retina and impact the visual potential. In our case series, all three patients had low presenting BCVA ranging from FCF‐5/60, which is consistent with previously published reports. Moreover, all patients had a final BCVA ranging from 6/36 to 6/6, which confirms a good response of FBA to focused specific treatment. All three zones were involved in the two patients with Behcet's disease and tuberculosis. This can be corroborated with reduced presenting BCVA and macular involvement. Zones 2 and 3 were involved in the patient with idiopathic FBA and can be very well correlated with the final BCVA of 6/6 in this variant.
The limitations of this case series include the retrospective nature of the case series and the small sample size of this specific entity. The evaluation done in cases is tailored individually based on the clinical scenario and not homogenously in all the patients. The electrophysiological tests could not be done in them due to feasibility and financial constraints. Beyond immunosuppressants, biologicals could not be initiated in the case of Behcet's associated FBA due to financial constraints.
After an extensive literature search and to the best of our knowledge, this is the first‐ever case series of FBA with specific documentation of the zones of involvement. 17 In particular, we attempted to formulate a diagnostic algorithm for the meticulous evaluation of FBA in a clinical scenario (Illustrated in Flowchart: Figure 9). This is a practical suggestion that merits being validated by future studies. Hence FBA is a clinical diagnosis of a diverse spectrum, which needs a high index of suspicion to identify the possible specific etiologies. Meticulous examination, close follow‐up, and tailored treatment are necessary for treatment success. We would like to refine the definition of FBA as a unique type of retinal vasculitis with a specific frosted branch configuration proven angiographically to reveal findings with or without occlusion and chorioretinal lesions. Table 3 depicts the review of literature of few important cases of FBA. Table 4 depicts the investigations required to rule out the etiology of FBA.
FIGURE 9.
Flowchart for diagnosis for FBA.
TABLE 3.
Review of literature of frosted branch angiitis.
Published data | Chan et al. 8 Ophthalmol Retina Dec 2018 | Wood et al. 9 J Ophthalmic Inflamm Infect Dec 2016 | Kim et al. 10 KJO Oct 2019 | Moustafa et al. 11 Clin Case Rep Aug 2018 | Agarwal et al. 12 Ocul Immunol Inflamma 2018 | Annamalai et al. 12 Oman J Ophthalmol Jan–Apr 2018 | Our case series |
---|---|---|---|---|---|---|---|
Etiology | Familial mediterranean fever | Antiphospholipid antibody syndrome | Wegner's granulomatosis |
Hodgkins lymphoma |
Typhoid fever | Sympathetic ophthalmia |
Heterogenous seven patients 1‐Tuberculosis 1‐Idiopathic 1‐Behcet's |
Laterality | LE | BE | LE | BE | LE | RE |
4 eyes, 1 B/L 2 U/L |
Age (years) | 47 | 28 | 70 | 71 | 16 | 25 | 31–47 |
Presenting visual acuity | 20/70 |
FCF RE 20/40 LE |
Finger counting at 30 cm |
20/30 RE 20/50 LE |
LE 6/18 | RE 6/9 | FCF‐5/60 |
Risk factor | Fever |
Acute kidney injury hemodialysis |
Stage IIa classical H.L. |
Typhoid fever | Trauma | Immunosuppression | |
Anterior segment | ‐ | An afferent pupillary defect was noted RE, 1+ anterior chamber cell on the right with no anterior chamber cell on the left. | Mild anterior uveitis | ‐ | Anterior chamber cells and flare 2+ with vitreous cells 2+ | Mutton‐fat keratic precipitates and aqueous cells1 + and aqueous flare 1 + . | Anterior uveitis all three patients with cells and flare, one had RAPD |
Posterior segment | Perivenular sheathing and hemorrhages | 2+ bilateral vitritis, bilateral diffuse retinal periphlebitis resembling frosted branch angiitis | Extensive perivascular sheathing, multiple retinal hemorrhages | Frosted branch pattern periphlebitis. | Mild vitreous haze, disc hyperemia, and extensive perivascular sheathing involving arterioles and venules in all the quadrants with an appearance characterized as “frosted branch angiitis” | 1+ vitreous haze and disc hyperemia with multiple Dalen‐Fuchs nodules, perivascular retinitis, and extensive vascular sheathing. | All had FBA like picture |
Investigation |
MEFV V726A mutation FFA OCT |
FFA OCT Blood tests anti‐nuclear antibody |
C‐ANCA Renal biopsy FFA OCT |
FFA CT Chest, abdomen, and pelvis PET scan |
Blood tests FFA OCT PCR |
FFA OCT USG B Scan |
Tailored to specific etiologies |
Treatment | Oral prednisone, Colchicine | Oral prednisone, at 1.5 mg/kg/day. |
IV Prednisolone 1 g/day for 3 days Oral cyclo phosphamide (100 mg/day) |
IV brentuximab vedotin and intraocular injections of bevacizumab1.25 mg/0.05 mL monthly for 4 months | Oral prednisolone 60 mg/day (1 mg/kg per day) | Oral azathioprine 50 mg three times daily and tablet prednisolone 60 mg along with antacid and calcium supplements. |
Topical and oral steroids, Cyclosporine‐Behcet's ATT‐Tuberculosis Steroids‐ Idiopathic |
Follow‐up | 1 month | 4 months | 6 months | 6 months | 3 months | 1 year | Minimum 1 year |
Final visual acuity | 20/30 | 20/20 | 6/15 |
20/25 RE 20/65 LE |
6/6 | 6/6 | 6/36–6/6 |
Remarks | No recurrences after use of colchicine | Criteria for diagnosis for APLA fulfilled but not SLE | IV Dexamethasone implant 2 months later for macular edema | Posttreatment‐subfoveal choroidal neovascular membrane | Treatment for enteric fever | Tablet cyclosporine, 150 mg twice daily, was added to the treatment. | Heterogenous etiologies, first case series on FBA, use of zones of involvement |
TABLE 4.
Depicts the investigation necessitated for diagnosing etiology of frosted branch angiitis.
S. No | Classification | FBA etiology | Investigations required |
---|---|---|---|
1 | Infection | Acquired immunodeficiency syndrome (AIDS) | CD 4 count, CD 8 count, CD4/CD8 ratio |
Tuberculosis | Mantoux, Chest Imaging, QuantiFERON Gold TB assay | ||
Cytomegalovirus, Epstein–Bar virus Herpes simplex virus 1 and 2 Influenza |
Viral IgG and IgM titers Polymerase chain reaction |
||
Typhoid Malaria Dengue Meningitis Staphylococcus, streptococcus |
Complete blood count (CBC), Widal test CBC, Peripheral blood smear CBC, Platelet count (specific) CBC, Lumbar puncture CBC, Culture and sensitivity |
||
Toxoplasma | CBC, IgG and IgM titers | ||
Infective endocarditis | CBC, Culture and sensitivity | ||
Endophthalmitis | B scan, Vitreous tap, biopsy and culture and sensitivity | ||
2 | Autoimmune/inflammation | Behcet's disease | Genetic workup, HLA B51 |
Systemic lupus erythematosus | Antinuclear antibody (ANA) titer | ||
Chron's disease | CBC, CECT, Endoscopy | ||
Antiphospholipid antibody syndrome | Lupus antibodies | ||
Wegner's granulomatosis | C‐ANCA, Chest IMAGING | ||
Vogt‐Koyanagi‐Harada syndrome | Fundus fluorescein angiography (FFA) | ||
Sympathetic ophthalmia | CBC, FFA | ||
Sarcoidosis | Chest imaging, angiotensin converting enzyme (ACE) levels | ||
3 | Infiltration | Acute lymphocytic leukemia, large cell lymphoma, Hodgkin's lymphoma | Peripheral blood smear, bone marrow biopsy |
Multiple myeloma | Bence Jones proteins | ||
Hemoglobinopathies | Electrophoresis | ||
4 | Miscellaneous | Foreign body | Imaging |
Pediatric dyskeratosis congenita | Genetic testing | ||
Familial Mediterranean testing | Genetic testing | ||
Pregnancy | Specific tests related to trimester | ||
5 | Others | Central retinal vein occlusion | CBC, blood pressure, lipid profile, plasma homocysteine levels |
3.1. Pointers for Future Research in Frosted Branch Angiitis
The exact antigens involved in eliciting this peculiar frosted branch configuration, the dynamic interplay of the varied innate, complement, and cellular immune systems with advanced molecular studies and imaging modalities using stable isotope labelling metabolomics, might shed additional insights to discern the pathogenesis of this distinct disease. It shall translate into targeted medical treatment and unravel the enigma of this heterogenous disease spectrum. There is also a need to compare FBA with or without capillary non‐perfusion areas and look for the predictors of good and poor outcomes with sufficiently larger sample size. There is also a felt need for large‐scale studies with specific diagnostic markers for the specific etiologies that shall facilitate the clinicians to pinpoint the etiologies of FBA elegantly.
AUTHOR CONTRIBUTIONS
Bharat Gurnani: Conceptualization; data curation; formal analysis; investigation; methodology; project administration; software; supervision; validation; visualization; writing – original draft; writing – review and editing. Sivaraman Balamurugan: Conceptualization; formal analysis; investigation; methodology; project administration; resources; supervision; validation; visualization. Anuradha Kanakath: Conceptualization; data curation; formal analysis; investigation; methodology; project administration; resources; software; validation; visualization; writing – original draft. Kirandeep Kaur: Conceptualization; data curation; formal analysis; investigation; methodology; project administration; resources; software; supervision; validation; visualization. Abhay Gupta: Data curation; investigation; methodology; visualization; writing – review and editing. Sameer Chaudhary: Investigation; methodology; writing – review and editing.
FUNDING INFORMATION
None.
CONFLICT OF INTEREST STATEMENT
There are no conflicts of interest.
ETHICS STATEMENT
At our institute case reports, images and case series are exempted from IRB approval and the research followed the tenets of the Declaration of Helsinki.
CONSENT
Written informed consent was obtained from all the patients to publish this case series in accordance with the journal's patient consent policy.
ACKNOWLEDGMENTS
Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry and Coimbatore.
Gurnani B, Balamurugan S, Kanakath A, Kaur K, Gupta A, Chaudhary S. First clinical case series of frosted branch angiitis: A diagnostic algorithm is suggested. Clin Case Rep. 2023;11:e7778. doi: 10.1002/ccr3.7778
Work was carried out at: Aravind eye hospital and post graduate institute of Ophthalmology, Cuddalore main road, Thavalukuppam, Pondicherry, and Coimbatore India.
DATA AVAILABILITY STATEMENT
The patient details are available in the electronic medical records and can be made available from the authors on request.
REFERENCES
- 1. Ito Y, Nakano M, Kyu N, Takeuchi M. Frosted branch angiitis in a child. Jpn J Clin Ophthalmol. 1976;30:797‐803. [Google Scholar]
- 2. Kleiner RC, Kaplan HJ, Shakin JL, Yannuzzi LA, Crosswell HH, McLean WC. Acute frosted retinal periphlebitis. Am J Ophthalmol. 1988;106(1):27‐34. [PubMed] [Google Scholar]
- 3. Walker S, Iguchi A, Jones NP. Frosted branch angiitis: a review. Eye. 2004;18(5):527‐533. [DOI] [PubMed] [Google Scholar]
- 4. Masuda K, Ueno M, Watanabe I. A case of frosted branch angiitis with yellowish‐white placoid lesions: fluorescein and indocyanine green angiography findings. Jpn J Ophthalmol. 1998;42(6):484‐489. [DOI] [PubMed] [Google Scholar]
- 5. Madanagopalan VG, Nagesha CK, Velis G, Devulapally S, Balamurugan S. Frosted branch angiitis with penetrating ocular trauma and retained intraocular foreign body. Indian J Ophthalmol. 2018;66(7):1031‐1033. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Zhao H, Guan J, Zhou L, Zhang Q, Si Y. Frosted branch angiitis in a woman with mycobacterium tuberculosis infection. Ocul Immunol Inflamm. 2012;20(3):227‐229. [DOI] [PubMed] [Google Scholar]
- 7. Al‐Mujaini A, Wali UK. Frosted branch angiitis, neuroretinitis as initial ocular manifestation in Behçet disease. Indian J Ophthalmol. 2011;59(3):240‐241. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Chan EW, Sun V, Chen JC. Frosted branch Angiitis associated with familial Mediterranean fever. Ophthalmol Retina. 2018;2(12):1249. [DOI] [PubMed] [Google Scholar]
- 9. Wood EH, Wong RW. Bilateral frosted branch angiitis as the presenting sign of antiphospholipid antibody syndrome. J Ophthalmic Inflamm Infect. 2016;6(1):20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10. Kim DY, Jeong J, Kim JY. Frosted branch Angiitis secondary to granulomatosis with Polyangiitis. Korean J Ophthalmol. 2019;33(5):485‐486. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11. Alhaj Moustafa M, Crowell EL, Elmahdy S, Malkovska V, Reddy AK. Paraneoplastic frosted branch angiitis as first sign of relapsed Hodgkin lymphoma. Clin Case Rep. 2018;6(10):1978‐1981. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12. Agarwal M, Malathi J, Biswas J. Frosted branch Angiitis in a patient with typhoid fever. Ocul Immunol Inflamm. 2018;26(5):776‐778. [DOI] [PubMed] [Google Scholar]
- 13. Annamalai R, Biswas J. Sympathetic ophthalmia presenting with signs of frosted branch angiitis: report of a case. Oman J Ophthalmol. 2018;11(1):49‐51. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Sangwan VS. Treatment of uveitis: beyond steroids. Indian J Ophthalmol. 2010;58(1):1‐2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15. Kwon SJ, Park DH, Shin JP. Frosted branch angiitis as ocular manifestation of Behçet's disease: unusual case report and literature review. Korean J Ophthalmol. 2013;27(6):466‐469. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16. Maleki SJ, Dourandish M, Hosseini SM. Primary idiopathic frosted branch Angiitis. J Ophthalmic Vis Res. 2020;15(3):424‐427. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17. Cunningham ET, Hubbard LD, Danis RP, Holland GN. Proportionate topographic areas of retinal zones 1, 2, and 3 for use in describing infectious retinitis. Arch Ophthalmol Chic. 2011;129(11):1507‐1508. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The patient details are available in the electronic medical records and can be made available from the authors on request.