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Sharma U, Rishi E, Rishi P, Gupta V, Raman R. Posterior segment manifestations of Takayasu arteritis: A narrative review. Indian J Ophthalmol 2024; 72:637-647. [PMID: 38648432 PMCID: PMC11168552 DOI: 10.4103/ijo.ijo_1346_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 04/25/2024] Open
Abstract
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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Affiliation(s)
- Unnati Sharma
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Ekta Rishi
- Truhlsen Eye Institute, University of Nebraska Medical Centre, Omaha, NE, USA
| | - Pukhraj Rishi
- Truhlsen Eye Institute, University of Nebraska Medical Centre, Omaha, NE, USA
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Rajshri H, Krishnappa NC, Arthi M. Blinding vasculitis: bilateral severe vision loss as a presenting feature of undiagnosed Takayasu arteritis. BMJ Case Rep 2022; 15:e251366. [PMID: 36109090 PMCID: PMC9478796 DOI: 10.1136/bcr-2022-251366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | | | - Mohankumar Arthi
- Vitreo-Retina, Rajan Eye Care Hospital, Chennai, Tamil Nadu, India
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Dammacco R, Cimino L, De Simone L, Alessio G, Dammacco F. Ocular Manifestations in an Italian Cohort of Patients with Takayasu Arteritis. Ocul Immunol Inflamm 2022:1-10. [PMID: 35584335 DOI: 10.1080/09273948.2022.2072348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE We describe ophthalmic manifestations, therapy, and outcomes in 16 patients with Takayasu arteritis (TA). METHODS Takayasu retinopathy was detected in 15 eyes of 9 patients and hypertensive retinopathy in 14 eyes of 7 patients. RESULTS Visual acuity was normal in 7 eyes, 20/40 to 20/200 in 20 eyes, counting fingers in 2 eyes, hand motion in 2 eyes, and no light perception in 1 eye. Glucocorticoids associated with immunosuppressive agents induced a sustained remission in 13 patients. Three relapsing-refractory patients were given the monoclonal antibody tocilizumab, which led to partial and complete response in 1 and 2 patients respectively. Steroid-induced cataracts developed in 4 patients. Restenosis and the consequent recurrence of visual symptoms were detected in 2 of 9 patients who underwent a patency procedure for their stenotic lesions. CONCLUSIONS Ocular manifestations were a common feature (37.2%) in our cohort of TA patients and were frequently responsible for severe visual deterioration. ABBREVIATIONS BCVA: best-corrected visual acuity; FFA: fundus fluorescein angiography; GC: glucocorticoids; HR: hypertensive retinopathy; ITAS: Indian Takayasu activity score; OCT: optical coherence tomography; TA: Takayasu arteritis; TR: Takayasu retinopathy.
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Affiliation(s)
- Rosanna Dammacco
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro," Medical School, Bari, Italy
| | - Luca Cimino
- Department of Surgery, Medicine,Dentistry and Morphological Sciences, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Ocular Immunology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Luca De Simone
- Ocular Immunology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Giovanni Alessio
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro," Medical School, Bari, Italy
| | - Franco Dammacco
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro," Medical School, Bari, Italy
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Poignet B, Bonnin P, Gaudric J, Chehaibou I, Vautier M, Tadayoni R, Gaudric A, Paques M, Bodaghi B, Saadoun D, Bonnin S. Correlation between Ultra-Wide-Field Retinal Imaging Findings and Vascular Supra-Aortic Changes in Takayasu Arteritis. J Clin Med 2021; 10:jcm10214916. [PMID: 34768435 PMCID: PMC8584942 DOI: 10.3390/jcm10214916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Takayasu arteritis (TA) is a chronic inflammatory large-vessel vasculitis. Ultra-wide-field imaging allows describing the retinal lesions in these patients and correlating them with vascular supra-aortic stenosis. (2) Methods: In total, 54 eyes of 27 patients diagnosed with TA were included, and a complete ophthalmological examination was performed, including UWF color fundus photography (UWF-CFP), fluorescein angiography (UWF-FA), and computed tomography angiography measuring supra-aortic stenosis. Eleven patients underwent Doppler ultrasound imaging assessing the blood flow velocity (BFV) in the central retinal artery (CRA). (3) Results: Microaneurysms were detected in 18.5% of eyes on fundus examination, in 24.4% of eyes on UWF-CFP, and in 94.4% of eyes on UWF-FA. The number of microaneurysms significantly correlated with the presence of an ipsilateral supra-aortic stenosis (p = 0.026), the presence of hypertension (p = 0.0011), and the duration of the disease (p = 0.007). The number of microaneurysms per eye negatively correlated with the BFV in the CRA (r = -0.61; p = 0.003). (4) Conclusions: UWF-FA improved the assessment of TA-associated retinal findings. The significant correlation between the number of microaneurysms and the BFV in the CRA gives new insight to our understanding of Takayasu retinopathy. The total number of microaneurysms could be used as an interesting prognostic factor for TA.
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Affiliation(s)
- Barthelemy Poignet
- Ophthalmology Department, Hopital Pitié Salpêtrière, Sorbonne University, 75013 Paris, France; (B.B.); (S.B.)
- Correspondence:
| | - Philippe Bonnin
- Clinical Physiology and Fonctionnal Explorations, Hôpital Lariboisière, University of Paris, 75010 Paris, France;
| | - Julien Gaudric
- Vascular Surgery Department, Hôpital Pitié Salpêtrière, Sorbonne University, 75013 Paris, France;
| | - Ismael Chehaibou
- Ophthalmology Department, Hôpital Lariboisière, University of Paris, 75010 Paris, France; (I.C.); (R.T.); (A.G.)
| | - Mathieu Vautier
- Immunopathology, Immunotherapies of Autoimmunes and Inflammatory Diseases, Hôpital Pitié-Salpêtrière, Sorbonne University, 75013 Paris, France;
- Department of Internal Medicine and Clinical Immunology, Hopital Pitié-Salpêtrière, Sorbonne University, 75013 Paris, France;
| | - Ramin Tadayoni
- Ophthalmology Department, Hôpital Lariboisière, University of Paris, 75010 Paris, France; (I.C.); (R.T.); (A.G.)
- Ophthalmology Department Fondation Adolphe de Rothschild, 75019 Paris, France
| | - Alain Gaudric
- Ophthalmology Department, Hôpital Lariboisière, University of Paris, 75010 Paris, France; (I.C.); (R.T.); (A.G.)
| | - Michel Paques
- Clinical Investigation Center CIC 1423, Quinze-Vingts Hospital, Sorbonne University, 75012 Paris, France;
| | - Bahram Bodaghi
- Ophthalmology Department, Hopital Pitié Salpêtrière, Sorbonne University, 75013 Paris, France; (B.B.); (S.B.)
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, Hopital Pitié-Salpêtrière, Sorbonne University, 75013 Paris, France;
| | - Sophie Bonnin
- Ophthalmology Department, Hopital Pitié Salpêtrière, Sorbonne University, 75013 Paris, France; (B.B.); (S.B.)
- Ophthalmology Department, Hôpital Lariboisière, University of Paris, 75010 Paris, France; (I.C.); (R.T.); (A.G.)
- Ophthalmology Department Fondation Adolphe de Rothschild, 75019 Paris, France
- Clinical Investigation Center CIC 1423, Quinze-Vingts Hospital, Sorbonne University, 75012 Paris, France;
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Abstract
PURPOSE OF REVIEW The orbit is subject to a variety of vascular insults that manifest with both specific and nonspecific patterns of vision compromise. The aim of the following review is to highlight the ophthalmic clinical features of systemic vasculitides that most frequently involve the orbit and differentiate them from the most common non-vasculitic orbital disorders. RECENT FINDINGS New studies continue to explore the autoimmune nature of vasculitic disease and seek to determine optimal use of newer therapies such as biologic agents. The pattern of ocular involvement in the context of clinical history allows the knowledgeable physician to distill a differential diagnosis into a specific or likely cause. Establishing a diagnosis in a timely fashion allows for a custom-tailored approach to therapy.
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Esen F, Ergelen R, Alibaz-Öner F, Çelik G, Direskeneli H, Kazokoğlu H. Ocular findings and blood flow in patients with Takayasu arteritis: a cross-sectional study. Br J Ophthalmol 2018; 103:928-932. [DOI: 10.1136/bjophthalmol-2018-312580] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/23/2018] [Accepted: 08/11/2018] [Indexed: 11/04/2022]
Abstract
Background/aimsTakayasu arteritis (TAK) is a chronic granulomatous vasculitis that can lead to ischaemic ocular complications. We aimed to document ocular complications, ocular blood flow and the association of them with systemic clinical findings in TAK.Material and methodsWe included 65 patients with TAK (60 female, 5 male, mean age: 41.8±12.9 years) and 30 healthy subjects (30 female, mean age: 39.0±7.5 years) in this study. All of the patients had a detailed rheumatological and ophthalmological evaluation. Ocular blood flow in ophthalmic artery (OA) and central retinal artery (CRA) was evaluated with colour Doppler ultrasonography.ResultsHypertensive retinopathy was observed in 33.9%, and Takayasu retinopathy was observed in 6.2% of patients. Posterior subcapsular cataracts or a history of cataract surgery was seen in 15.4% of the cases. None of the patients experienced visual loss due to ischaemic or neovascular complications. Patients with TAK had increased resistivity index (RI) in ophthalmic artery (0.75 vs 0.66, p=0.002) and CRA (0.75 vs 0.67, p=0.001). Patients with hypertensive retinopathy had significantly longer disease duration (p=0.016). Ophthalmic artery RI was significantly higher in patients with ipsilateral radial artery pulselessness compared with patients without (0.77 vs 0.68, p=0.031).ConclusionThis study reported the lowest prevalence of Takayasu retinopathy and is the only series without permanent visual loss. We documented for the first time that radial artery pulselessness can predict reduction of ipsilateral ocular perfusion. We believe that better management of TAK with current medications reduced ocular complication rates.
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Kal A, Duman E, Sezenöz AS, Ulusoy MO, Kal Ö. Evaluation of retrobulbar blood flow and choroidal thickness in patients with rheumatoid arthritis. Int Ophthalmol 2017; 38:1825-1831. [PMID: 28730400 DOI: 10.1007/s10792-017-0656-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/15/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate whether retrobulbar blood flow and choroidal thickness (CT) are affected in patients with rheumatoid arthritis (RA), and the relationship between these values. METHODS We evaluated 40 eyes of 20 RA patients and 40 eyes of 20 healthy controls. The enhanced depth imaging optical coherence tomography, color Doppler imaging, was held. Statistical analysis was performed. RESULTS Peak systolic velocity (PSV) of ophthalmic (OA) and central retinal artery (CRA) were significantly higher in RA. No significant difference was observed when end-diastolic velocity (EDV) of OA and CRA was compared between the groups. The resistivity index (RI) of OA and CRA was higher in RA. Perifoveal/subfoveal CT was lower in RA. Negative correlation was detected between the RI of OA and the perifoveal CT, and a positive correlation was detected between RI of CRA and CT. CONCLUSIONS Ocular hemodynamics is effected by RA and can exaggerate ocular complications of various vascular diseases such as diabetes mellitus, hypertension, retinal vascular occlusions.
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Affiliation(s)
- Ali Kal
- Department of Ophthalmology, Baskent University, Konya, Turkey.
- Göz Hastaliklari ABD, Baskent Üniversitesi Tıp Fakültesi, Hoca Cihan Mh. Saray Cd.No:1, 42080, Konya, Turkey.
| | - Enes Duman
- Department of Radiology, Baskent University, Konya, Turkey
| | | | | | - Öznur Kal
- Department of Nephrology, Baskent University, Konya, Turkey
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Abstract
PURPOSE OF REVIEW The primary systemic vasculitides represent a spectrum of rare but life-threatening conditions that may also affect the eye in various forms. This article reviews recently published data on ocular manifestations of systemic vasculitis. RECENT FINDINGS Early diagnosis and timely treatment has led to better visual outcomes in giant cell arteritis (GCA). Gene expression from orbital tissues could distinguish granulomatosis with polyangiitis (GPA) from sarcoidosis and Graves disease, but not from idiopathic orbital inflammation. Rituximab was an effective therapeutic option in ocular GPA. An ocular attack severity scoring system, flare levels, fluorescein angiography and optical coherence tomography parameters have been suggested as predictors of visual prognosis in Behçet disease. Efficacy of tumor necrosis factor-alpha inhibitors, interferon α and anti-interleukin-1 agents was shown in noncontrolled studies of ocular Behçet disease. SUMMARY Widely used fast-track pathway care as well as ocular imaging to detect subclinical involvement may enable earlier diagnosis of GCA and prevention of permanent visual loss. Orbital inflammation may not remain idiopathic with advances in gene expression profiling of orbital tissues. With an increased availability and the use of biologic agents, visual prognosis will improve in patients with severe ocular complications of systemic vasculitides.
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