Maurice F. Rabb » Macro And Microvascular Sea Fan Changes

A 19 year old male was first seen at the Mayo Clinic in February of 1975 at which time he was considered to have seronegative symptomatic rheumatoid arthritis with mild Raynaud's phenomenon.

He first presented to the Eye Department with complaints of blurred vision in February of 1979. The visual acuity was recorded as 20/20 in each eye. Salient findings were confined to the fundi of each eye. Each showed singularly unusual macro and microvascular changes. Many of the larger peripheral veins were dark in color, dilated, and sheathed, and in some areas completely occluded. Hemorrhages were distributed along the occluded vessels. Additionally, there were numerous ischemic infarcts and superficial hemorrhages and some of the peripheral arteries appeared occluded. A fluorescein angiogram demonstrated an absence of dye leakage from the vessel walls, central to the occlusive sites. Therapy with systemic steroids was increased and the fundus appearance gradually improved and the vision remained stable.

In January of 1980, the vision was 20/20, O.U., and the fundi showed no hemorrhages, although a single ischemic infarct was visible on the nasal fundus of the left eye. In June of 1980, multiple focal sites of sea fan vascular proliferations were visible bilaterally. The fluorescein angiogram clearly demonstrated the arteriolar origin of these sea fans.