Multimodal imaging in bilateral ocular ischaemic syndrome with anterior ischaemic optic neuropathy in a case of Takayasu arteritis

Reddy, S. Rama; Tyagi, Mudit; Suresh, Anjali; Dogra, Avantika

doi:10.1136/bcr-2020-236351

Cited by 3 publications

(11 citation statements)

References 9 publications

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“…Among them, 2 were written in Chinese (6 patients) (18,25), and the remaining 47 (59 patients) were published in English. Included studies were published between 1957 and 2021, the types of which were case reports (40 articles) (7,8,16,17,19,, case series (7 articles) (3,17,18,20,(59)(60)(61), and image-based articles (2 articles) (21,62). The methodological quality assessment showed that 8 studies were of good quality, 33 studies were of moderate quality, and 8 studies were of poor quality (Supplementary Table 1).…”

Section: Literature Search Resultsmentioning

confidence: 99%

“…Four cases had CDI performed pre-and postoperatively, showing marked improvement of hemodynamics in the ophthalmic artery (27,32,34,34). One case with bilateral stage IV TR showed complete regression of optic disc neovascularization on OCTA after carotid endarterectomy (21). Of note, two eyes contralateral to the surgical side had unexpected visual improvement.…”

Section: Outcomes Of Surgical Therapymentioning

confidence: 97%

“…In 5 eyes (3 patients) that presented with AION, 4 eyes experienced visual improvement (8,21), while 1 eye remained stable (60). Consequently, all eyes showed optic disc pallor after surgery.…”

Section: Outcomes Of Surgical Therapymentioning

confidence: 99%

“…Including our case, 52 patients (99 eyes, 78.8%) were assumed to have TR, among which 2 eyes (2%) were at stage I, 40 eyes (40.4%) were at stage II, 15 eyes (14.1%) were at stage III, and 37 eyes (38.4%) were at stage IV. Of note, two cases with bilateral TR had associated AION (21,50). Stage of retinopathy was not identified in 3 cases due to delayed presentation (27) or lack of detailed fluorescein angiogram (48,59).…”

Section: Demographic Characteristics and Clinical Featuresmentioning

confidence: 99%

“…Ocular prognosis varies between individual studies, in part due to different study populations and perioperative management. Although most previous studies have exclusively used fundus fluorescein angiography (FFA) for followup surveillance in TA, few studies looked at retinal perfusion in the macula, especially with the advent of optical coherence tomography (OCT) angiography (OCTA) (21,22). A detailed summary of existing data is therefore necessary to clarify surgical outcomes in this particular cohort.…”

Section: Introductionmentioning

confidence: 99%

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

Zeng

Duan

et al. 2022

Front. Immunol.

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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.

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Section: Literature Search Resultsmentioning

confidence: 99%

Section: Outcomes Of Surgical Therapymentioning

confidence: 97%

Section: Outcomes Of Surgical Therapymentioning

confidence: 99%

Section: Demographic Characteristics and Clinical Featuresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Zeng

Duan

et al. 2022

Front. Immunol.

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Ocular Manifestations of Takayasu’s Arteritis—A Case-Based Systematic Review and Meta-Analysis

Szydełko-Paśko

Przeździecka-Dołyk

Nowak

et al. 2023

JCM

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Takayasu’s arteritis (TA) is a type of vasculitis in which inflammation develops in large vessels, especially in the aorta and its branches. Our study aims to determine the prevalence and type of ocular manifestations in TA. A systematic literature search was conducted in December 2022 using three electronic databases (PubMed, Scopus, and Web of Science). The following data were extracted from each article: the name of the first author; the patient’s age, sex, and origin (continent); circumstances connected with the diagnosis of TA; symptoms given by the patients; reported ocular manifestations; and administered treatment. The final analysis was based on data collected from 122 cases. Retinal ischemia, followed by optic neuropathy, cataract, and retinal artery occlusion, were the most prevalent eye conditions associated with the disease. Systemic steroid therapy, vascular procedures, and methotrexate were mainly used to treat pulseless disease. Patients mostly complained of gradual vision acuity loss, sudden vision acuity loss, ocular pain, and amaurosis fugax. The diagnosis of Takayasu’s arteritis should be considered in patients presenting symptoms of visual decline/loss, ocular pain, or signs of retinal ischemia, optic neuropathy, or early cataract formation. A proper diagnosis is crucial to ensure the patient receives treatment without significant delay.

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Posterior segment manifestations of Takayasu arteritis: A narrative review

Sharma,

Rishi,

Rishi

et al. 2024

Indian Journal of Ophthalmology

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Ocular symptoms can be the presenting manifestation of Takayasu arteritis (TA) or could be indicative of disease reactivation. A review of published literature related to posterior segment manifestations of TA by using the keywords “Takayasu arteritis,” “ophthalmic manifestations,” “retina,” “retinopathy,” “ocular,” “optic nerve,” and “optic neuropathy” was performed. In total, 62 case reports and 12 case series were included. The majority of the articles were from Asia (n = 47, 64%). Females outnumbered males in the ratio of 7:1. The mean age of patients was 33 years (range: 8–78 years, SD: 13.5 years). In 58% (n = 41 out of 71) cases, ocular symptoms were the presenting manifestation of the underlying disease. Hypotensive retinopathy was found in 70% of eyes, and hypertensive retinopathy was found in 27%. The mean presenting visual acuity (VA) was +1.03 logMAR (range: −0.12 to 3, SD: 1.07), and at the final follow-up was +1.02 logMAR (range: −0.12 to 3, SD 1.17). VA improved in 34% (n = 29/86), remained stable in 45% (39/86), and worsened in 21% (18/86). The mean follow-up was 9 months (range: 0.5–204, SD: 16 months).

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Multimodal imaging in bilateral ocular ischaemic syndrome with anterior ischaemic optic neuropathy in a case of Takayasu arteritis

Cited by 3 publications

References 9 publications

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

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

Ocular Manifestations of Takayasu’s Arteritis—A Case-Based Systematic Review and Meta-Analysis

Posterior segment manifestations of Takayasu arteritis: A narrative review

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