Retinal Capillary Reperfusion from Ischemic Retinal Vasculitis in Henoch-Schonlein Purpura: A Case Report

Introduction: We present a case of ischemic retinal vasculitis in adult-onset Henoch-Schonlein purpura (HSP) and the first report of capillary reperfusion through regenerative angiogenesis using optical coherence tomography angiography (OCTA). Case report: A 34-year-old male complained of bilateral blurred vision after successive episodes of abdominal pain, purpura, and hematuria. Fundus examination showed perivascular infiltration and phlebitis. Fluorescein angiography and OCTA revealed extensive capillary nonperfusion. Laser photocoagulation was performed on the peripheral nonperfused area. Intravenous methylprednisolone with azathioprine was administered and continuously tapered. With consecutive OCTA follow-up, the capillary nonperfusion of the maculae progressively reperfused. Capillary buds and loops emerged within the nonperfused area, continued to elongate and branch, and finally connected with adjacent preexisting capillaries. Conclusions: Regenerative angiogenesis was the mainstay process for capillary reperfusion in this patient. Systemic steroid therapy might support capillary reperfusion and recover the damaged ischemic maculae from ischemic retinal vasculitis of HSP.