scholarly journals FRI0201 OPHTHALMOLOGICAL FEATURES AT DIAGNOSIS AND IN RECURRENCES IN PATIENTS WITH GIANT CELL ARTERITIS CONFIRMED BY BIOPSY IN A TERTIARY HOSPITAL

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 684.2-684
Author(s):  
A. De Diego Sola ◽  
N. Alcorta Lorenzo ◽  
J. A. Valero Jaimes ◽  
C. A. Egüés Dubuc ◽  
O. Maiz-Alonso ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Optic Neuropathy ◽  
Central Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Lower Percentage ◽  
Ischemic Optic Neuropathy ◽  
Temporal Artery Biopsy ◽  
Visual Symptoms ◽  
Cilioretinal Artery Occlusion

Background:Giant cell arteritis (GCA) presents with visual symptoms in approximately 37%1of patients at diagnosis. Patients with visual symptoms present, according to some series, lower levels of C-reactive protein (CRP) at diagnosis and associate less headache, fever, cranial nodules or polymyalgia (PM).Relapses despite glucocorticoid treatment (GC) are frequent (40-60%). Visual symptoms are very rare in relapses (0% in several series). Since most series focus on northern European populations, it is interesting to study the characteristics in our population.Objectives:To describe visual manifestations in both diagnosis and recurrence of stroke, only in patients diagnosed with temporal artery biopsy. To analyze demographic, clinical and analytical features in patients with and without visual symptoms.Methods:We retrospectively reviewed the medical records of patients with positive biopsy for GCA at our center from January 2000 through December 2018. Relapse was defined as the appearance of clinical symptoms in a previously asymptomatic patient requiring a dose increase or restart of GCS. Patients with no response to GCS were not included. Qualitative variables are shown with absolute value and percentage and quantitative variables with mean and standard deviation (SD). Kruskal Wallis, Fisher test and Mann-Whitney U test were used for bivariate analysis.Results:52 patients were found: 39 women (73.6%), with an average age at diagnosis of 77.6 years (SD 6.3). At diagnosis, 28 presented visual symptoms (53.84%): oculomotor paralysis 5 (9.61%), amaurosis fugax 8 (15.38%), blindness 6 (11.54%), decreased visual acuity 8 (28.57%) and other visual symptoms 1 (1.92%). Eleven had monocular symptoms (38%) and 9 binocular (32%), in 10 patients this data was not collected. The symptoms were permanent in 11 (39.2%) despite GC. Type of visual impairment was: Anterior Ischemic Optic Neuropathy (AION) (12, 42.86%), impairment of cranial pairs (5, 17.86%), central retinal artery occlusion (1, 3.57%), cilioretinal artery occlusion (1, 3.57%) and Posterior Ischemic Optic Neuropathy (1, 3.57%).Of the 52 patients, 17 (32.69%) presented a minimum of one recurrence and 3 (5.77%) presented 2 or more. No patient relapsed with visual clinic.There were no differences among patients with and without visual symptoms in the variables studied (table 1). However, patients with visual symptoms at diagnosis had numerically less PM and cranial nodules.Table 1.Demographic, clinical and analytical differences between patients with/without visual symptomsVariablesWith visual symptoms (28)Without visual symptoms (24)ESR >5017 (60.7%)15 (62.5%)ESR <504 (14.3%)2 (8.33%)CRP>1017 (60.7%)13 (54.16%)CRP <103 (10.7%)2 (8.33%)Cephalea24 (85,7%)23 (95,8%)Polymyalgia9 (32,1%)12 (50%)Constitutional syndrome9 (32,1%)7 (29,1%)Jaw claudication17 (60.7%)12 (50%)Cranial nodules4 (14,3%)8 (33,3%)Sex: Man/Woman9/195/19Previous PM diagnosis4 (14,3%)3 (12,5%)Conclusion:In our series, 53% of the patients presented visual symptoms at diagnosis, a number higher than that described in the literature. It is important to remember that only patients with biopsy-confirmed ACG were included. The most frequent manifestations were AION followed by oculomotor paralysis. A numerically lower percentage of PM and cranial nodules was observed at diagnosis in patients with visual symptoms compared to patients without them, as seen in some series. The absence of visual clinic in recurrences coincides with that reported in the available literature.References:[1]Alba M et al. Relapses in Patients With Giant Cell Arteritis Prevalence, Characteristics, and Associated Clinical Findings in a Longitudinally Followed Cohort of 106 Patients. Medicine. 2014;93: 194–201.Disclosure of Interests:None declared

Neuro-Ophthalmic Complications of Biopsy-Proven Giant Cell Arteritis

1997 ◽  
Vol 7 (4) ◽  
pp. 375-382 ◽  
Author(s):  
S. Glutz Von Blotzheim ◽  
F.-X. Borruat
Keyword(s):  
Fluorescein Angiography ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Temporal Artery ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Ischemic Optic Neuropathy ◽  
Temporal Artery Biopsy ◽  
Choroidal Ischemia ◽  
Retinal Artery

Purpose To define the spectrum of neuro-ophthalmic complications and clinical presentations of patients with giant cell arteritis (GCA). Methods Retrospective study (1977-1994) of clinical charts, fundus photographies and fluorescein angiographies of 66 patients with temporal artery biopsy positive for GCA. Results Clinical data were adquate for 47 patients. Headaches were reported by 83%, weight loss in 73%, jaw claudication in 68%, scapular pain in 64% and asthenia in 57%. Erythrocyte sedimentation rate was normal in 15%. Neuro-ophthalmic complications were present in 33 cases (70%), including anterior ischemic optic neuropathy (22 cases), choroidal ischemia (17 cases), central or branch retinal artery occlusion (seven cases), and oculomotility disturbances (four cases). Fluorescein angiography was very helpful for detecting choroidal ischemia (80.9% of our cases). Twenty-one patients presented with involvement of several distinct orbital arterial territories and one very unusual patient suffered from an orbital infarction (i.e. ischemia of all orbital structures). Conclusions In our series, two-thirds of biopsy-proven GCA patients presented with neuro-ophthalmic complications, ranging from transient visual loss to orbital infarction. Involvement of more than one orbital vascular territory is highly suggestive of an arteritic process. Clinicians should keep in mind the possibility of GCA even when ESR is normal, and fluorescein angiography should be performed. The finding of choroidal ischemia should prompt temporal artery biopsy and steroid therapy.

scholarly journals An Atypical Presentation of Giant Cell Arteritis with Bilateral Choroidal Ischaemia

2020 ◽  
pp. 1-4
Author(s):  
Craig Wilde ◽  
Craig Wilde ◽  
Mary Awad ◽  
Winfried M. Amoaku
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Neck Pain ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Central Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Temporal Artery Biopsy ◽  
Fluorescein Angiogram ◽  
The Right

Background: Giant cell arteritis is an immune-mediated, medium to large vessel vasculopathy affecting individuals over 50 years of age. It can cause sudden, severe and irreversible loss of vision, most commonly from an arteritic posterior ciliary artery occlusion causing anterior ischaemic optic neuropathy. The optic nerve appearance would typically be swollen and chalky white. Visual reduction secondary to choroidal ischaemia is a much less frequent presentation, the signs of which can be more subtle in appearance, making its early recognition potentially more challenging. Case Presentation: A 51-year-old male presented to eye casualty complaining of a one-week history of neck pain, intermittent headaches and jaw claudication, associated with reduced vision in his right eye. Presenting visual acuity was hand movements and 6/5 in the right and left eyes respectively. On examination, he was noted to have a right relative afferent pupillary defect, a pale macular area in the right eye with a possible cherry red spot. There was no optic disc swelling. ESR was 34 and CRP was 46 and he was wrongly diagnosed with a non-arteritic central retinal artery occlusion. He subsequently re-presented 5 weeks later with vision loss in his left eye. Best corrected visual acuity was now 6/60 and 6/12 in the right and left eyes respectively. Dilated fundoscopy showed multiple yellow-white lesions in the posterior pole of the left eye and a retinal cotton wool spot. The right optic nerve was pale, and left was normal. A fundus fluorescein angiogram showed delayed choroidal filling and the temporal artery biopsy was suggestive of GCA. He was started on 110mgs of oral prednisolone. After 4 weeks of steroids his BCVA was 6/36 and 6/6 in the right and left eyes respectively. His neck pain, headaches and jaw claudication had all resolved and his ESR and CRP had returned to normal levels. Conclusion: Our case highlights the need for increased awareness of this uncommon presentation of this potentially blinding disease, to allow prompt and appropriate treatment. Our case is unusual in that despite a delayed diagnosis of 5 weeks, visual acuity initially improved with treatment.

scholarly journals Visual Manifestations in Giant Cell Arteritis: Trend over 5 Decades in a Population-based Cohort

2014 ◽  
Vol 42 (2) ◽  
pp. 309-315 ◽  
Author(s):  
Abha G. Singh ◽  
Tanaz A. Kermani ◽  
Cynthia S. Crowson ◽  
Cornelia M. Weyand ◽  
Eric L. Matteson ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Optic Neuropathy ◽  
Vision Loss ◽  
Population Based ◽  
Ischemic Optic Neuropathy ◽  
Visual Symptoms ◽  
The Past ◽  
Trends Over Time ◽  
Visual Changes

Objective.To evaluate clinical characteristics, treatment, and outcomes of patients with visual changes from giant cell arteritis (GCA) and to examine trends over the last 5 decades.Methods.We reviewed the medical records of a population-based cohort of patients with GCA diagnosed between 1950 and 2004. The clinical, ophthalmological, and laboratory features of patients with visual manifestations attributable to GCA were compared to patients without visual complications. Trends over time were examined using logistic regression modeling adjusted for age and sex.Results.In a cohort of 204 cases of GCA (mean age 76.0 ± 8.2 yrs, 80% female), visual changes from GCA were observed in 47 patients (23%), and 4.4% suffered complete vision loss. A higher proportion of patients with visual manifestations reported jaw claudication than did patients without visual changes (55% vs 38%, p = 0.04). Over a period of 55 years, we observed a significant decline in the incidence of visual symptoms due to GCA. There was a lower incidence of ischemic optic neuropathy in the 1980–2004 cohort vs 1950–1979 (6% vs 15%, p = 0.03). Patients diagnosed in later decades were more likely to recover from visual symptoms (HR 1.34, 95% CI 1.06–1.71). Chances of recovery were poor in patients with anterior ischemic optic neuropathy or complete vision loss.Conclusion.Incidence of visual symptoms has declined over the past 5 decades, and chances of recovery from visual symptoms have improved. However, complete loss of vision is essentially irreversible. Jaw claudication is associated with higher likelihood of development of visual symptoms.

Cytomegalovirus Retinal Necrosis With Occlusive Vasculopathy Secondary to Steroid Immunosuppression for Giant Cell Arteritis

2020 ◽  
Vol 4 (3) ◽  
pp. 227-232
Author(s):  
Anne Zeng ◽  
Ron Strauss ◽  
Sarah E. Goglin ◽  
John Gonzales ◽  
Varun K. Pawar ◽  
...  
Keyword(s):  
Case Report ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Vision Loss ◽  
Oral Prednisone ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Ischemic Optic Neuropathy ◽  
The Right

Purpose: This case report discusses an atypical case of cytomegalovirus (CMV) retinal necrosis with panretinal occlusive vasculopathy in a 77-year-old man who was immunosuppressed following treatment for giant cell arteritis (GCA). Methods: A case report is presented. Results: Clinical examination demonstrated a central retinal artery occlusion and pale disc suspicious for arteritic ischemic optic neuropathy in the right eye. Biopsy-proven GCA prompted treatment with oral prednisone. While on glucocorticoid immunosuppression, the patient suffered vision loss in the left eye from CMV-necrotizing retinitis with occlusive vasculopathy. Treatment controlled the CMV infection but tapering of his steroids resulted in worsening GCA, requiring a steroid-sparing treatment, tocilizumab. Conclusions: Corticosteroid immunosuppression for GCA may lead to immune dysfunction allowing for an atypical occlusive vasculitis with retinal necrosis from CMV. Early identification and treatment are essential to adjust the level of immunosuppression and consider alternate therapies to control the GCA and prevent worsening of this opportunistic infection.

scholarly journals Bilateral Arteritic Anterior Ischemic Optic Neuropathy Associated with Giant Cell Arteritis in Korea

2017 ◽  
Vol 31 (5) ◽  
pp. 466 ◽  
Author(s):  
Hyeon-Jeong Yoon ◽  
Sang-Woo Park ◽  
Ho-Kyun Lee ◽  
Yoo-Duk Choi ◽  
Hwan Heo
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Optic Neuropathy ◽  
Anterior Ischemic Optic Neuropathy ◽  
Ischemic Optic Neuropathy
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