‘Eye is a window to the pulse’: bilateral ocular ischaemic syndrome as a presenting manifestation of Takayasu arteritis

Shailaja, S; Vivek, G; Shetty, Ranjan; Kamath, Yogish Subraya

doi:10.1136/bcr-2013-009461

Cited by 14 publications

(9 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Detailed ocular examinations from the anterior to posterior segment are essential in patients with unexplained conjunctival chemosis, corneal epithelium erosion, ophthalmoplegia, CRVO, or asymmetric retinopathy to exclude the possibility of OIS. OIS should also be taken into account as a differential diagnosis of uveitis, dry eye, and anterior pole ischemia syndrome, especially in unilateral cases that are nonresponsive to conventional treatment [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Analysis of 42 Cases of Ocular Ischemic Syndrome

Luo

Yan

Jia

et al. 2018

Journal of Ophthalmology

View full text Add to dashboard Cite

Ocular ischemic syndrome (OIS) is a severe ocular disease caused by ocular hypoperfusion due to stenosis or occlusion of the common or internal carotid arteries. OIS is easily misdiagnosed or undiagnosed given its asymptomatic onset and complicated ocular manifestations. The present study reviewed 42 patients with OIS, including 30 males (71.43%), 29 older patients (69.05%, >61 yrs), and 35 patients (83.33%) with two or more systemic diseases. Only 6 patients had ocular symptoms as the initial signs upon visiting the Department of Ophthalmology of three hospitals (the First Affiliated Hospital, Sun Yat-sen University; Zhongshan Ophthalmic Center, Sun Yat-sen University; and the Second Affiliated Hospital, Guangzhou Medical University). The ocular symptoms varied from visual deterioration to periorbital pain. Thirty-seven patients (88.10%) complained of constitutional symptoms. Ocular manifestations were diverse and involved both anterior and posterior segments. We reported a case of corneal edema and corneal epithelium erosion in the ipsilateral eye due to internal carotid artery stenosis. As the clinical manifestations of OIS are complex, ophthalmologists must carefully examine patients to avoid a misdiagnosis or a failure to diagnose. The management of OIS requires cooperation with cardiologists and neurologists.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical Analysis of 42 Cases of Ocular Ischemic Syndrome

Luo

Yan

Jia

et al. 2018

Journal of Ophthalmology

View full text Add to dashboard Cite

show abstract

“…Two patients died in the medical group: one due to a cardiac accident and the other due to a cerebrovascular event (49,58). In the surgical group, one modality was observed during bypass grafting surgery due to severe carotid steal syndrome (31).…”

Section: Complicationsmentioning

confidence: 99%

Therapeutic Management of Ocular Ischemia in Takayasu’s Arteritis: A Case-Based Systematic Review

Zeng

Duan

et al. 2022

Front. Immunol.

View full text Add to dashboard Cite

BackgroundTakayasu’s arteritis (TA) is a rare, chronic granulomatous large-vessel vasculitis that can lead to ocular ischemia. Ocular outcomes after therapeutic management in TA remain largely unknown. We herein conduct a case-based systematic review to address the current treatment options in this particular cohort.MethodsPubMed, Medline, and EMBASE databases were searched pertaining to ocular outcomes after systemic treatment in TA. Studies reporting ocular examinations before and after treatment in TA patients with ocular ischemia were included. Clinical characteristics, therapies, ocular outcomes, and complications were recorded.ResultsA 29-year-old woman with newly diagnosed TA showed dramatic regression of Takayasu’s retinopathy (TR) following balloon angioplasty. Optical coherence tomography angiography (OCTA) was used as a novel strategy for subsequent follow-up. A total of 117 eyes of 66 patients with a median age of 27 years were included for systematic review. TR was the most common ocular manifestation. Oral steroids were prescribed in nearly all patients (n = 65), followed by the use of methotrexate and antiplatelet therapy. Of the patients, 65.8% and 34.2% underwent open surgery and endovascular procedure, respectively. The median follow-up period was 12 weeks (interquartile range 8–33.5). Surgical therapy showed better ocular improvement (including visual and imaging responses) in both acute and chronic vision loss, along with fewer complications than medical therapy alone. In the surgical group, the visual prognosis was significantly better in patients with initial visual acuity better than 20/200 (p = 0.03) and those who underwent surgery before stage III TR (p = 0.01). Ocular outcomes were equivalent in the two surgical approaches.ConclusionClinicians should be familiar with ophthalmic manifestations of this potentially treatable complication in TA. Compared with medical therapy alone, surgical intervention might be a better choice for both acute and chronic vision loss. Surgery is best recommended before the onset of irreversible ischemia to the globe. A combined regimen (oral steroids, immunosuppressants, and antiplatelet drugs) might be effective for those with surgical contradictions or reluctance to an invasive procedure. Physicians should be aware of the importance of ocular examinations, including OCTA, during the diagnosis and follow-up in TA.

show abstract

“…OIS is a rare initial presentation of TA and its prevalence is unknown. Currently, we have found and retrieved eight case reports recently published to provide context regarding the different management techniques and outcomes of these patients ( Table 1 ) [ 7 - 14 ]. Here, we report a case of worsening vision in a 26-year-old female with OIS in TA and discuss our approach for diagnosis and treatment.…”

Section: Introductionmentioning

confidence: 99%

Takayasu Arteritis Presenting as Bilateral Ocular Ischemic Syndrome

Larrazabal

Chiu

Santiago

2020

VSI

View full text Add to dashboard Cite

A 26-year-old female came in with progressive blurring of vision. She had developed memory loss and complained of headache, significant weight loss, and exertional left calf pain after prolonged walking. Pertinent physical findings included light perception on visual acuity examination, and the brachial and radial pulses of both arms were not appreciable. Thoracic and abdominal aortic imaging by computed tomography with contrast revealed narrowing along the thoracic aorta and its branches. Carotid Doppler showed bilaterally thickened walls in the common carotid arteries, with near total occlusion of the left carotid artery. These findings were consistent with bilateral ocular ischemic syndrome in Takayasu arteritis. She was given methylprednisolone 500 mg intravenously daily for 3 days with noted improvement in vision. She was discharged and showed improvement on prednisone 35 mg/day and aspirin 80 mg/day. On follow-up two weeks post-discharge, she reported being able to see silhouettes of persons and objects.

show abstract

‘Eye is a window to the pulse’: bilateral ocular ischaemic syndrome as a presenting manifestation of Takayasu arteritis

Cited by 14 publications

References 4 publications

Clinical Analysis of 42 Cases of Ocular Ischemic Syndrome

Clinical Analysis of 42 Cases of Ocular Ischemic Syndrome

Therapeutic Management of Ocular Ischemia in Takayasu’s Arteritis: A Case-Based Systematic Review

Takayasu Arteritis Presenting as Bilateral Ocular Ischemic Syndrome

Contact Info

Product

Resources

About