Frosted Branch Angiitis in Ocular Immunology
Summary
Frosted branch angiitis (FBA) is an uncommon form of retinal vasculitis distinguished by translucent, sheath-like exudation encasing both arterioles and venules. Clinically, patients present with sudden visual disturbance, floaters, vitritis and often severe macular oedema. The condition may arise idiopathically or secondary to a range of triggers including viral infections (notably cytomegalovirus in immunocompromised hosts), autoimmune disorders (such as Behçet’s disease or systemic lupus erythematosus), paraneoplastic processes and immune-reconstitution inflammatory syndrome following antiretroviral therapy. Pathophysiologically, FBA reflects an exaggerated immune response within the retinal microvasculature, mediated by circulating immune complexes, activated T-cells and proinflammatory cytokines. Diagnostic evaluation combines detailed fundus examination, fluorescein angiography, optical coherence tomography and laboratory assays—including aqueous-humour PCR for infectious agents—to distinguish primary idiopathic FBA from secondary forms. Management hinges on prompt systemic corticosteroids, tailored immunosuppression or antiviral therapy as dictated by underlying aetiology; intravitreal steroid injections or plasmapheresis may be employed in refractory cases. Early recognition and multidisciplinary collaboration between ophthalmology, immunology and infectious-disease specialists are essential to preserve vision and address systemic disease associations.
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Frosted Branch Angiitis in Ocular Immunology publication trend
The graph below shows the total number of articles in frosted branch angiitis in ocular immunology across all publications each year (not limited to Nature Index journals).
Technical terms
Retinal vasculitis: Inflammation of retinal blood vessels causing leakage and sheathing.
Perivascular sheathing: Deposition of inflammatory exudates around retinal vessels, resembling frosted branches.
Immune reconstitution inflammatory syndrome (IRIS): Exacerbation of immune-mediated inflammation after recovery of immune function, often following antiretroviral therapy.
Macular oedema: Accumulation of fluid within the macula leading to central vision impairment.
Intravitreal injection: Delivery of medication directly into the vitreous cavity of the eye.
References
- Sudden bilateral vision loss: a case report of frosted branch angiitis following pentavalent vaccination in a 2-year-old boy. Journal of Ophthalmic Inflammation and Infection (2025).
- Frosted branch angiitis due to cytomegalovirus-associated unmasking immune reconstitution inflammatory syndrome: a case report and literature review. BMC Infectious Diseases (2021).
- Frosted branch angiitis and cerebral venous sinus thrombosis as an initial onset of neuro-Behçet’s disease: a case report and review of the literature. Journal of Medical Case Reports (2017).
- Frosted branch angiitis as a result of immune recovery uveitis in a patient with cytomegalovirus retinitis. Journal of Ophthalmic Inflammation and Infection (2013).
- Paraneoplastic frosted branch angiitis as first sign of relapsed Hodgkin lymphoma. Clinical Case Reports (2018).
- Frosted branch angiitis presenting after a SARS-CoV-2 infection. Journal of Ophthalmic Inflammation and Infection (2022).
- Frosted branch angiitis in a patient with systemic juvenile idiopathic arthritis: a case report. BMC Ophthalmology (2024).
- Unilateral Frosted Branch Angiitis Treated with Intravitreal Dexamethasone Implant. International Journal of Ophthalmology & Visual Science (2020).
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