Arteritic Anterior Ischemic Optic Neuropathy Associated with Giant-Cell Arteritis in Korean Patients: A Retrospective Single-Center Analysis and Review of the Literature

Choi, Jae Hwan; Shin, Jong Hoon; Jung, Jae Ho

doi:10.3988/jcn.2019.15.3.386

Cited by 9 publications

(4 citation statements)

References 34 publications

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“…Normal values of these data in the context of low clinical suspicion are enough to safely rule out GCA and TAB is not necessary in these cases [10][11]. The visual prognosis is extremely unfavorable in acute unilateral arteritic-AION, and the visual outcome did not improve in the patients in other studies [12][13][14].…”

Section: Discussionmentioning

confidence: 85%

Giant Cell Arteritis Presenting as Unilateral Arteritic Anterior Ischemic Optic Neuropathy

Mandura

2021

Cureus

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Giant cell arteritis (GCA) is a rare inflammatory vasculitis of unknown cause that involves large and medium arteries. Arteritic anterior ischemic optic neuropathy (AAION) is attributed to vascular occlusion of the posterior ciliary arteries (PCAs) which supply the optic nerve head (ONH). AAION is the most common ophthalmic complication of GCA and can cause sudden and irreversible loss of vision with a high risk of involvement of the second eye. A 57-year-old female patient presented with unilateral sudden onset visual loss in the right eye (OD) for two days. It was accompanied by severe right-sided headache and scalp tenderness on the right temple, neck as well as the presence of jaw pain over the past three months. Visual acuity (VA) was hand motion (HM) OD, and 20/20 in the left eye (OS). Fundus examination revealed diffuse swollen optic disc with pallid "chalky white" appearance OD and normal healthy optic disc OS. A dramatically elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were found. Therefore, a diagnosis of GCA was made, and immediate IV methylprednisolone was started followed by oral prednisone doses. A right temporal artery (TA) biopsy was done later and was negative. On followup, VA has maintained at HM level OD, and no involvement of the second eye occurred. GCA is a rare form of vasculitis that can be difficult to diagnose especially in the setting of negative TA biopsy. We support the evidence that negative TA biopsy does not rule out clinically suspected GCA with elevated ESR and CRP and recommend keeping a low index of suspicion as immediate treatment is required to prevent irreversible vision loss.

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Section: Discussionmentioning

confidence: 85%

Giant Cell Arteritis Presenting as Unilateral Arteritic Anterior Ischemic Optic Neuropathy

Mandura

2021

Cureus

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“…When reported, ophthalmologic outcomes improved (9%), remained stable (33%), or worsened (7%) at follow-up. Seven cases reported follow-up MR exams, among which 6 cases [21; 25; 30; 35; 37; 38] reported resolution and 1 case [39] reported no improvement.…”

Section: Resultsmentioning

confidence: 99%

Orbital Magnetic Resonance Imaging of Ocular Giant Cell Arteritis: A Systematic Review and Individual Participant Data Meta-Analysis

Guggenberger

Pavlou

Cao

et al. 2022

Preprint

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Objectives: Spectrum and prevalence of orbital MRI findings in patients with giant cell arteritis with ischemic optic neuropathy are unknown. We conducted a systematic review and individual participant data meta-analysis of publications reporting the ophthalmologic presentation, clinical exam, and orbital MRI findings in ocular giant cell arteritis. Methods: PubMed and Cochrane databases were searched from inception to January 16, 2022. Publications reporting patient-level data on patients with ophthalmic symptoms, imaged with orbital MRI and diagnosed with biopsy-proven giant cell arteritis were included. Demographics, clinical symptoms, exam, lab, imaging, and outcomes data were extracted. Descriptive statistics were used to report prevalence rates. Methodological quality and completeness of reporting of the case reports were assessed. Results: Thirty-two studies were included comprising 51 patients (females=24; median age, 76 years). Vision loss (78%) and headache (45%) were commonly reported visual and cranial symptoms. Ophthalmologic presentation was unilateral (41%) or bilateral (59%). Fundus examination most commonly showed disc edema (64%) and pallor (49%). Average visual acuity was very poor (2.28 logMAR ± 2.18). Diagnoses included anterior (61%) and posterior (16%) ischemic optic neuropathy, central retinal artery occlusion (8%) and orbital infarction syndrome (2%). Erythrocyte sedimentation rate and c-reactive protein were elevated in 83% and 42% of cases, respectively. On MRI, enhancement of the optic nerve sheath (53%), intraconal fat (25%), and optic nerve/chiasm (14%) was most prevalent. Among patients with monocular visual symptoms, 38% showed pathologic enhancement in the asymptomatic orbit. Six of seven cases reported imaging resolution after treatment on follow-up MRIs. Incomplete reporting were limitations in this study. Conclusions: Vision loss, pallid disc edema, and optic nerve sheath enhancement are the most common clinical, fundoscopic and imaging findings reported in patients diagnosed with ocular giant cell arteritis, respectively. MRI may detect subclinical inflammation in the asymptomatic eye and may be an adjunct diagnostic tool.

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“…Therefore, studies regarding the clinical profiles and outcomes of East Asian patients with GCA are limited. Among the Korean population, one retrospective study investigated seven patients with arteritic anterior ischemic optic neuropathy (AAION) associated with GCA, but the study focused on the ophthalmological manifestations of the disease [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and courses of Korean patients with giant cell arteritis: a multi-center retrospective study

Lee,

Park,

Jung

et al. 2024

J Rheum Dis

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Giant cell arteritis (GCA) is a large-vessel vasculitis that primarily affects elderly individuals. However, data regarding Korean patients with GCA are scarce owing to its extremely low prevalence in East Asia. This study aimed to investigate the clinical characteristics of Korean patients with GCA and their outcomes, focusing on relapse. Methods: The medical records of 27 patients with GCA treated at three tertiary hospitals between 2007 and 2022 were retrospectively reviewed. Results: Seventeen (63.0%) patients were females, and the median age at diagnosis was 75 years. Large vessel involvement (LVI) was detected in 12 (44.4%) patients, and polymyalgia rheumatica (PMR) was present in 14 (51.9%) patients. Twelve (44.4%) patients had fever at onset. The presence of LVI or concurrent PMR at diagnosis was associated with a longer time to normalization of the C-reactive protein level (p=0.039) or erythrocyte sedimentation rate (p=0.034). During follow-up (median: 33.8 months), four (14.8%) patients experienced relapse. Kaplan-Meier analyses showed that relapse was associated with visual loss (p=0.008) and the absence of fever (p=0.004) at onset, but not with LVI or concurrent PMR. Conclusion: Concurrent PMR and LVI were observed in approximately half of Korean patients with GCA, and the elapsed time to normalization of inflammatory markers in these patients was longer. The relapse rate in Korean GCA is lower than that in Western countries, and afebrile patients or patients with vision loss at onset have a higher risk of relapse, suggesting that physicians should carefully monitor patients with these characteristics.

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Arteritic Anterior Ischemic Optic Neuropathy Associated with Giant-Cell Arteritis in Korean Patients: A Retrospective Single-Center Analysis and Review of the Literature

Cited by 9 publications

References 34 publications

Giant Cell Arteritis Presenting as Unilateral Arteritic Anterior Ischemic Optic Neuropathy

Giant Cell Arteritis Presenting as Unilateral Arteritic Anterior Ischemic Optic Neuropathy

Orbital Magnetic Resonance Imaging of Ocular Giant Cell Arteritis: A Systematic Review and Individual Participant Data Meta-Analysis

Clinical characteristics and courses of Korean patients with giant cell arteritis: a multi-center retrospective study

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