Optical coherence tomographic angiography identifies peripapillary microvascular dilation and focal non-perfusion in giant cell arteritis

2017 ◽  
Vol 102 (8) ◽  
pp. 1141-1146 ◽  
Author(s):  
Eric D Gaier ◽  
Aubrey L Gilbert ◽  
Dean M Cestari ◽  
John B Miller
Keyword(s):  
Visual Field ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Optic Neuropathy ◽  
Visual Field Loss ◽  
Clinical Severity ◽  
Optical Coherence ◽  
Ischaemic Optic Neuropathy ◽  
Perfusion Defects ◽  
Tomographic Angiography

AimsWe set out to determine the optical coherence tomographic angiography (OCT-A) characteristics of arteritic anterior ischaemic optic neuropathy (AAION) in the context of giant cell arteritis (GCA).MethodsThis is an observational case series of four patients with AAION secondary to GCA, three with unilateral AAION and one with bilateral AAION. We reviewed the charts, fundus photography, visual fields, fluorescein angiography (FA) and OCT-A images for all patients to identify a unifying theme in a range of AAION clinical severity. Imaging of two healthy control eyes from two patients of similar age to the patients in our series were used for comparison.ResultsSuperficial peripapillary capillary dilation was seen in eyes with acute AAION. It was also noted in the fellow eyes of two patients. Retinal capillary perfusion defects corresponded to visual field loss. Dense optic disc oedema and cotton-wool spots imparted blockage effects. OCT-A laminar analysis did not highlight the choroidal/choriocapillaris perfusion defects seen on FA in two patients. Follow-up OCT-A was obtained in two patients and revealed progression to superficial peripapillary capillary attenuation that corresponded with visual field loss.ConclusionsThere are acute and chronic vascular changes in AAION that are detectable by OCT-A that correspond with visual function. Though the microvascular changes seen in GCA and AAION are not specific, the nearly ubiquitous findings among preclinical and clinically affected eyes in this series of patients with GCA support OCT-A as a potentially useful adjunctive diagnostic test in the work-up of ambiguous cases of suspected ischaemic optic neuropathy.

scholarly journals Detection of choroidal hypoperfusion in giant cell arteritis using swept-source optical coherence tomographic angiography

2021 ◽  
Author(s):  
Edward S Lu ◽  
Amy Yuan ◽  
Devon A Cohen ◽  
Raviv Katz ◽  
John B Miller ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Control Patient ◽  
Case Series ◽  
Ocular Involvement ◽  
Optical Coherence ◽  
Swept Source ◽  
Retinal Capillary ◽  
Tomographic Angiography ◽  
Choroidal Perfusion

Objective: To determine whether swept-source optical coherence tomographic angiography (SS-OCTA) can demonstrate choroidal perfusion abnormalities seen on fluorescein angiography (FA) in giant cell arteritis (GCA). Design: Observational case series. Participants: Six eyes of 3 patients with bilateral ischemic optic neuropathy secondary to GCA, and one control patient without ocular involvement from biopsy-confirmed GCA. Methods: En face SS-OCTA (DRI OCT Triton, Topcon, Tokyo, Japan) and FA centered on the macula were obtained at presentation. SS-OCTA was segmented into superficial and deep retinal capillary plexuses and the choriocapillaris laminae. SS-OCTA images were independently analyzed for perfusion abnormalities and compared with corresponding FA images. Main Outcome Measures: Correspondence of choroidal angiographic abnormalities on SS-OCTA and FA. Results: SS-OCTA showed decreased angiographic signal within the choriocapillaris in 5/6 eyes and corresponded to hypoperfusion abnormalities on FA in similar geographic distributions in 5/5 eyes. SS-OCTA also showed dilation of the deep retinal capillary plexus overlying the area of choroidal hypoperfusion in one eye. In the one eye without angiographic signal abnormalities on SS-OCTA, no perfusion changes were noted on FA. One control patient without ocular involvement from biopsy-confirmed GCA did not show choroidal perfusion changes on SS-OCTA or FA. Conclusions: This case series demonstrates comparability between SS-OCTA and FA in detection and characterization of choroidal hypoperfusion secondary to GCA. As a rapid and non-invasive tool, SS-OCTA may serve as a viable alternative to FA in the diagnostic evaluation of GCA.

Giant cell arteritis presenting with hemianopic visual field loss

2007 ◽  
Vol 42 (3) ◽  
pp. 486-487 ◽  
Author(s):  
Sandeep Randhawa ◽  
Gregory P. Van Stavern
Keyword(s):  
Visual Field ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Visual Field Loss

Arteritic anterior ischaemic optic neuropathy: An update

2021 ◽  
pp. 112067212110094
Author(s):  
Vidhi Bajpai ◽  
Siddharth Madan ◽  
Sarita Beri
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Optic Neuropathy ◽  
Visual Loss ◽  
Literature Search ◽  
Clinical Approach ◽  
Temporal Artery Biopsy ◽  
Management Protocol ◽  
Ischaemic Optic Neuropathy ◽  
Anterior Ischaemic Optic Neuropathy

Ischaemic optic neuropathy (ION) is a major cause of blindness. The clinical approach and management is a matter of debate for the treating neurologist and the ophthalmologist. Of the two broad varieties namely the posterior (PION) and anterior ischaemic optic neuropathy (AION), the arteritic variety of the AION (AAION) is usually due to giant cell arteritis. Giant cell arteritis may only present with visual loss in up to 25% of cases. AAION is a neuro-ophthalmic emergency. Early recognition and differentiation from AAION is imperative in order to prevent further devastating visual loss. A literature search was conducted on pubmed using key words as AAION, arteritic anterior ischaemic optic neuropathy, giant cell arteritis (GCA) and articles from the year 2000 till date were included. In any case very few reviews are available on AAION. The literature search on pubmed provided holistic overview about this clinical significant entity and the same is compiled in this review. Moreover the histopathologic features of a temporal artery biopsy have been described with its microscopic images. In any case reviews are mostly available on the Non arteritic variety of AION. This review recapitulates the diagnostic and management protocol of a patient presenting with AAION.

scholarly journals OP0147 MEASUREMENT OF FLOW VELOCITIES OF THE CENTRAL RETINAL ARTERY IN PATIENTS WITH GIANT CELL ARTERITIS WITH VISUAL SYMPTOMS AND CONTROLS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 93.2-94
Author(s):  
L. C. Burg ◽  
P. Brossart ◽  
K. I. Reinking ◽  
R. P. Finger ◽  
C. Behning ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Resistance Index ◽  
Visual Field Loss ◽  
Central Retinal Artery ◽  
Control Group ◽  
Visual Symptoms ◽  
Retinal Artery ◽  
The Mean ◽  
Flow Velocities

Background:Giant cell arteritis (GCA) is the most common form of systemic vasculitis in patients aged 50 years and older.1Visual symptoms such as amaurosis, diplopia, temporary or permanent visual field loss secondary to optic nerve ischemia are common manifestations.2The value of vascular ultrasound of extra-ocular vessels in diagnosing GCA is well established.3However, the role of transocular ultrasound of the central retinal artery in GCA patients has not yet been established.Objectives:To identify changes in flow velocities of the central retinal artery in GCA patients with visual symptoms and controls with transocular high resolution ultrasound.Methods:Prospective analysis of GCA patients with visual symptoms and controls. Ultrasound of the central retinal artery was performed in 18 newly diagnosed consecutive GCA patients with visual symptoms (GCA-group) and 25 controls without ocular pathology. Visual symptoms included amaurosis, diplopia and temporary or permanent visual field loss. For each eye, peak systolic values (PS) and end diastolic values (ED) were recorded. Furthermore, the resistance index of each central retinal artery was measured.Results:Twenty-one of 36 eyes of 18 GCA patients were affected. Therefore 21 central retinal were measured. The control group consisted of 50 central retinal arteries of 25 eye-healthy individuals. The mean age and gender distribution of the GCA-group were 75.6 years (SD± 8.1) with eight females (44 %) and 67 years (SD± 8.9) with twelve females (48%) in the control group. The mean flow velocity of the central retinal artery was PS 12.2 cm/s (SD± 3.5) and ED 3.7 cm/s (SD± 1.2) in the GCA group and PS 14.4 cm/s (SD± 3.2) and ED 5.1 cm/s (SD± 1.6) in the control group. The mean RI was 0.9 (SD± 0.3) in the GCA group and 0.8 (SD± 0.3) in the control group. Mean reduction in flow velocity in the GCA-group was PS 2.1 cm/s (p= 0.039) and ED 1.4 (p= 0.0004) cm/s, while the RI was increased by 0.14 (p= 0.077). The results for PS and ED measurements were statistically significant, while the results for RI were not significant.Conclusion:In GCA patients with ocular symptoms, a reduction of flow velocities of the central retinal artery compared to the eye-healthy control group was found. Results for PS and ED were significant. There seems to be a trend for decreased flow velocities in coexistence with visual symptoms in patients with GCA.References:[1]Warrington KJ, Matteson EL. Management guidelines and outcome measures in giant cell arteritis (GCA). Clin Exp Rheumatol 2007;25:137–41.[2]Chean CS, Prior JA, Helliwell T, et al. Characteristics of patients with giant cell arteritis who experience visual symptoms. Rheumatol Int 2019;39:1789–96.[3]Dejaco C, Ramiro S, Duftner C, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis 2018;77:636–43Figure 1.Transocular ultrasound of an affected eye in giant cell arteritis with reduced flow velocities and increased resistance index.Disclosure of Interests:None declared

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