Regression of Takayasu Retinopathy After Revascularization of Occluded Branches of the Aortic Arch by Percutaneous Angioplasty

Peter, Jayanthi; Joseph, George; David, Sachin; Danda, Debashish

doi:10.1097/icb.0b013e31828eef72

Cited by 7 publications

(7 citation statements)

References 8 publications

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“…Interestingly, our patient had a dramatic resolution of retinopathy after surgery, whereas little regression of radiological lesions was found. A similar trend was also noticed in 3 cases in the literature, all of which displayed sustained ocular improvement in spite of persistent vascular inflammation, postsurgical embolism, and graft narrowing (19,29,40). Possible explanations could be the lack of standardized imaging for follow-up interpretations and the progressive nature of ocular ischemia.…”

Section: Discussionsupporting

confidence: 77%

“…Restenosis occurred in 2 cases: in-stent restenosis (ISR) in one case (59) and graft narrowing in the other (19). A vascular event due to embolism from diseased vessels was reported 6 months after stenting in one case (29). For the ISR patient, her good vision started to deteriorate 6 months postoperatively when ISR occurred, which improved again after repeated angioplasty.…”

Section: Complicationsmentioning

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: Discussionsupporting

confidence: 77%

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.

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“…[ 4 ] An earlier report of a 37-year-old female of TA with retinopathy and diminution of vision also documented an improvement in symptoms after percutaneous angioplasty and stenting. [ 5 ]…”

Section: Discussionmentioning

confidence: 99%

“…Till date, improvement of vision in TA following endovascular revascularization has been very infrequently reported in literature. [ 3 4 5 ] Herein, we report a case of Takayasu retinopathy with retinochoroidal and optic nerve hypoperfusion who improved following percutaneous endovascular revascularization with the stent. Informed consent was obtained from the patient for the publication purpose.…”

Section: Introductionmentioning

confidence: 99%

Visual outcome after endovascular intervention in Takayasu arteritis

Sharma¹,

Jain²,

Pal³

et al. 2022

Taiwan J Ophthalmol

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Takayasu arteritis is a chronic multisystem vasculitis which has been known to be associated with myriad of ophthalmological manifestations. Steroids and immunomodulators are the mainstay of medical management in early stages of disease. We report the case of a 15-year-old girl with complaints of diminution of vision in both the eyes. Her ophthalmic examination suggested a diagnosis of Takayasu retinopathy with posterior ischemic optic neuropathy in her left eye and ocular ischemic syndrome in the right eye. Digital subtraction angiography revealed a significant narrowing of major vessels originating from the arch of aorta and the left vertebral artery. She underwent left subclavian artery and left vertebral artery balloon angioplasty followed by left vertebral artery stenting. Her vision improved significantly postprocedure, suggesting that endovascular intervention in the later stages of disease is a promising treatment modality for Takayasu retinopathy.

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“…1 Takayasu retinopathy can be categorized into four different stages. 13 Initially stage 1 presents with distension of the veins, stage 2 displays microaneurysm formation, stage 3 shows arteriovenous anastamosis formation, and finally stage 4 shows ischemic complications. 13 Visual acuity tends to be unaffected during the first three stages due to preservation of macular function.…”

Section: Presentation/risk Factorsmentioning

confidence: 99%

Collateral Damage: A Differential of Takayasu Retinopathy

Duong

2020

CRO (Clinical &Amp; Refractive Optometry) Journal

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Background: Takayasu retinopathy is the ocular manifestation of Takayasu arteritis, a vasculitis affecting the aorta and aortic branches. Ocular manifestations are a result of cerebral and ophthalmic nonperfusion, and are noted in 8.1% to 68% of patients with Takayasu arteritis. Management of Takayasu retinopathy relies on treatment of the underlying systemic condition. Case Report: A 60 year old African American male was referred for a comprehensive eye exam after abnormal findings were noted on his diabetic teleretinal exam. Upon clinical examination, the patient was diagnosed with moderate to severe diabetic retinopathy, and a fluorescein angiography was ordered due to the presence of irregular vessels on the optic nerves. Takayasu retinopathy was considered as a differential diagnosis after review of the fluorescein angiography. Further work up with magnetic resonance angiography (MRA) showed no signs of significant stenosis. Conclusion: Takayasu retinopathy is a rare ocular manifestation that can aide in diagnosing a rare and previously undetected systemic disease of Takayasu arteritis. It is important for primary eye care providers to be assertive in performing additional diagnostic tests to prevent misdiagnosis and management of an underlying systemic condition. CE Notification: This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com/collateral-damage-a-differential-of-takayasu-retinopathy) Please check COPE course expiry date prior to enrollment. The COPE course test must be taken before the course expiry date.

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Regression of Takayasu Retinopathy After Revascularization of Occluded Branches of the Aortic Arch by Percutaneous Angioplasty

Abstract: Restoration of flow in the aortic arch vessels may result in reversal of ischemic retinal changes in patients with Takayasu retinopathy.

Cited by 7 publications

References 8 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

Visual outcome after endovascular intervention in Takayasu arteritis

Collateral Damage: A Differential of Takayasu Retinopathy

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