Varying Spectrum of Frosted Branch Angiitis: A Curated Constellation of Cases.

Abstract

Purpose: The purpose of this study is to elucidate varying etiology and presentations of frosted branch angiitis (FBA), a rare immune-mediated retinal vasculitis. Methods: In this case series, four curated cases confined to varying spectrums of FBA have been described. Detailed fundoscopic documentation with pertinent imaging was performed in all the cases. The cases were managed adequately as per protocol and retrospectively analyzed. Results: Our first case is unique as it has been rarely reported in extant ophthalmic literature. The case is presented as progressive outer retinal necrosis in cytomegalovirus (CMV) retinitis accompanied by FBA. The second case is a Kleiner Type 3 FBA with viral prodrome. Our third case is the fourth reported case in literature of FBA following penetrating trauma. This case is instrumental in confirming the hypothesis of Type 3 hypersensitivity reaction in the slow deposition of immune complexes in the periarteriolar region as a pathophysiology for FBA. The fourth case is the first reported case of coexisting bilateral flecked retina and FBA. It also had an unusual association with tuberculosis mimicking tubercular vasculitis. Conclusion: This gamut of unique cases may contribute to a better understanding of the variability of clinical presentation of FBA in a more detailed manner for future reference.