Transient visual loss due to reversible ‘pending’ central retinal artery occlusion in occult giant cell arteritis

Sane, Mona; Selvadurai, A; Reidy, James J.; Higgs, Donald E.; Gonzalez‐Fernandez, Federico; Lincoff, Norah S.

doi:10.1038/eye.2014.181

Cited by 9 publications

(3 citation statements)

References 8 publications

(2 reference statements)

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“…In cases with sparing of the cilioretinal artery circulation, the visual prognosis after GCA is less clear. Sane et al [9] described the case of a 62-year-old woman with biopsy-confirmed GCA with episodes of vision loss in the right eye (visual acuity of 20/25 OD compared to 20/20 OS) that was found to have normal choroidal circulation but delayed filling of the retinal arterioles. This case affected the central retinal artery as it came off the ophthalmic artery, and the posterior ciliary circulation was relatively spared [9].…”

Section: Discussionmentioning

confidence: 99%

Cilioretinal Sparing Central Retinal Artery Occlusion from Giant Cell Arteritis

Kasimov

Popović

Micieli

2022

Case Rep Ophthalmol

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A 93-year-old woman presented with a 1-day history of sudden painless vision loss in her right eye with a background of new temporal headaches and jaw claudication. Dilated fundus examination of the right eye showed mild retinal whitening and edema throughout the right fundus with selective sparing in the distribution of the cilioretinal artery. A diagnosis of giant-cell arteritis (GCA) was made and confirmed with temporal artery biopsy. Oral prednisone was initiated and her vision improved to 20/200 in the right eye at 3-month follow-up. GCA-related cilioretinal artery sparing central retinal artery occlusion is rare and may have mild improvement with promt treatment.

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Section: Discussionmentioning

confidence: 99%

Cilioretinal Sparing Central Retinal Artery Occlusion from Giant Cell Arteritis

Kasimov

Popović

Micieli

2022

Case Rep Ophthalmol

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“…Given the poor prognosis of GCA-related vision loss, the improvement in visual symptoms seen here was impressive. Central retinal artery occlusion causes inner retinal infarction with irreversible visual loss sustained within hours31; a ‘pending’, rather than complete occlusion, may have permitted sufficient retinal vascular perfusion to keep the retina viable 32. The profoundly reduced retinal nerve fibre layer in the right eye at 6 months’ follow-up (figure 2) implies that the optic nerve head arterial supply (which includes the central retinal artery and short posterior ciliary arteries) was certainly compromised.…”

Section: Discussionmentioning

confidence: 99%

Rapid visual recovery following intravenous tocilizumab in glucocorticoid resistant refractory giant cell arteritis

Svasti-Salee¹,

Mollan

Morgan

et al. 2019

BMJ Case Rep

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A 72-year-old man presented with a short history of headache, jaw claudication, double vision, amaurosis fugax and distended temporal arteries. A diagnosis of giant cell arteritis (GCA) was confirmed on temporal artery ultrasound and temporal artery biopsy. Despite treatment with high-dose oral glucocorticoid (GC) and multiple pulses of intravenous methylprednisolone, his vision deteriorated to hand movements in one eye. 8 mg/kg intravenous tocilizumab, a humanised, recombinant anti-IL-6 receptor antibody, was administered within 48 hours of vision loss and continued monthly, resulting in marked visual improvement within days, as well as sustained remission of GCA. This case suggests a possible role for tocilizumab as a rescue therapy to prevent or recover visual loss in patients with GCA resistant to GC treatment, termed refractory GCA. Further research is required to elucidate the role of intravenous administration of tocilizumab in this setting.

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“…C-reactive protein and sedimentation rates were elevated, and although fundus exam was normal, fluorescein angiography showed delayed and sluggish filling of retinal arterioles, probably due to reversible thrombotic occlusion or retinal vasospasm. 32 Management of TVL when caused by GCA is based on proper diagnosis and treatment of the arteritis itself.…”

Section: Tvl and Thromboembolic Vascular Diseasementioning

confidence: 99%

Update on the evaluation of transient vision loss

Pula¹,

Kwan²,

Yuen³

et al. 2016

OPTH

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Transient vision loss may indicate underlying vascular disease, including carotid occlusion and thromboembolism, or it may have a more benign etiology, such as migraine or vasospasm. This review focuses on the differential diagnosis and workup of patients presenting with transient vision loss, focusing on several key areas: the relationship to thromboembolic vascular disease, hypercoagulable testing, retinal migraine, and bilateral vision loss. The objective is to provide the ophthalmologist with information on how to best manage these patients. Thromboembolic etiologies for transient vision loss are sometimes managed with medications, but when carotid surgery is indicated, earlier intervention may prevent future stroke. This need for early treatment places the ophthalmologist in the important role of expediting the management process. Hospital admission is recommended in patients presenting with transient symptoms within 72 hours who meet certain high-risk criteria. When the cause is giant cell arteritis, ocular ischemic syndrome, or a cardioembolic source, early management of the underlying condition is equally important. For nonthromboembolic causes of transient vision loss such as retinal migraine or retinal vasospasm, the ophthalmologist can provide reassurance as well as potentially give medications to decrease the frequency of vision loss episodes.

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Transient visual loss due to reversible ‘pending’ central retinal artery occlusion in occult giant cell arteritis

Cited by 9 publications

References 8 publications

Cilioretinal Sparing Central Retinal Artery Occlusion from Giant Cell Arteritis

Cilioretinal Sparing Central Retinal Artery Occlusion from Giant Cell Arteritis

Rapid visual recovery following intravenous tocilizumab in glucocorticoid resistant refractory giant cell arteritis

Update on the evaluation of transient vision loss

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