Case report of lyme disease associated proliferative vitreoretinopathy, challenges in diagnostic and treatment

A woman 30 y. with complains of gradual bilateral visual loss and headache during 6 months. Vis OD=0.25, Vis OS=0.04. Anterior eye segment without changes, IOP normal. On the eye fundus – massive proliferative changes and partial hemophthalmia. Serology negative for Tuberculosis, Sarcoidosis, Lues, Antiphospholipid syndrome and Rheumatologic spectrum.  Serology positive for Lyme disease. She was consulted and treated by infectionist. Previous weeks the patient was taken oral steroids and admitted short time improvement and then the new portion of hemophthalmia appeared. In our clinic was performed Fluorescent angiography, where the presence of neuro vasculitis was confirmed, with massive peripheric fibrovascular proliferation and wide avascular zones. We started with intravitreal injections of anti-VEGF and laser coagulation of avascular zones.  Few weeks later her visual acuity was Vis OD= 0.9, Vis OS=0.7. As there were residual vitreoretinal tractions and local tractional retinal detachment, we performed vitrectomy with gas endo tamponade. And now her vision is 1.0 on both eyes.