Giant cell arteritis

Hayreh, Sohan Singh

doi:10.4103/ijo.ijo_1681_20

Cited by 46 publications

(54 citation statements)

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“…Despite the fact that choroidal ischemia is described as being rare in the present literature [ 18 , 25 – 29 ], it is probable that this irregularity of the choroidal circulation is frequently overlooked. The current research and other communications [ 30 , 31 ] confirm that choroidal ischemia is frequently seen. (Table 2 ).…”

Section: Discussionsupporting

confidence: 79%

Choroidal ischemia as one cardinal sign in giant cell arteritis

Casella

Mansour

et al. 2022

Int J Retin Vitr

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Purpose To describe chorioretinal signs in a case series of Giant Cell Arteritis (GCA). Methods This is a multicenter retrospective observational case series with GCA that presented with a headache and an abrupt, unilateral loss in vision. Workup included temporal artery biopsies, intravenous fluorescein angiography, optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), blood levels of erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Results There are a total of 8 GCA instances presented. Average age was 74.5. (Range 68–83 years). The patients reported that one eye's visual loss had suddenly started, along with a fresh headache and other systemic symptoms. Eight patients exhibited choroidal ischemia, five paracentral acute middle maculopathy (PAMM) lesions, five cotton wool spots, four anterior ischemic optic neuropathy, and one central retinal arterial occlusion at the time of presentation. The average ESR at presentation was 68 mm/hr (range 4–110), and 4/6 individuals had a significant increase. The mean CRP level was 6.2 mg/dL (range 2.0–15.4), and the level was always over the normal range. All patients' temporal artery biopsies were positive. Conclusion Alongside PAMM lesions, cotton wool spots, anterior ischemic optic neuropathy, and central retinal artery occlusion, choroidal ischemia is a key angiographic indicator in the diagnosis of GCA. It may be crucial to recognize these typical ischemic chorioretinal signs while diagnosing GCA.

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Section: Discussionsupporting

confidence: 79%

Choroidal ischemia as one cardinal sign in giant cell arteritis

Casella

Mansour

et al. 2022

Int J Retin Vitr

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“…The frequency of ocular involvement in GCA varies widely, from 10% to 70%. 2 , 3 , 8 , 31 – 33 GC represent the cornerstone of the therapy for GCA, and adequate doses quickly improve clinical manifestations and prevent most additional cranial ischemic events. 2 , 34 Therefore, GC therapy must be started as soon as GCA is suspected to reduce the risk of blindness.…”

Section: Discussionmentioning

confidence: 99%

“…Some features of the disease such as amaurosis fugax or jaw claudication have been associated with PVL, whereas others such as PmR appeared to be associated with a reduced risk of visual complications. 1 , 2 , 5 , 8 , 31 , 40 …”

Section: Discussionmentioning

confidence: 99%

Tocilizumab in visual involvement of giant cell arteritis: a multicenter study of 471 patients

Loricera

Castañeda

Moriano

et al. 2022

Therapeutic Advances in Musculoskeletal

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Background: Visual involvement is the most feared complication of giant cell arteritis (GCA). Information on the efficacy of tocilizumab (TCZ) for this complication is scarce and controversial. Objective: We assessed a wide series of GCA treated with TCZ, to evaluate its role in the prevention of new visual complications and its efficacy when this manifestation was already present before the initiation of TCZ. Design: This is an observational multicenter study of patients with GCA treated with TCZ. Methods: Patients were divided into two subgroups according to the presence or absence of visual involvement before TCZ onset. Visual manifestations were classified into the following categories: transient visual loss (TVL), permanent visual loss (PVL), diplopia, and blurred vision. Results: Four hundred seventy-one GCA patients (mean age, 74 ± 9 years) were treated with TCZ. Visual manifestations were observed in 122 cases (26%), of which 81 were present at TCZ onset: PVL ( n = 60; unilateral/bilateral: 48/12), TVL ( n = 17; unilateral/bilateral: 11/6), diplopia ( n = 2), and blurred vision ( n = 2). None of the patients without previous visual involvement or with TVL had new episodes after initiation of TCZ, while only 11 out of 60 (18%) patients with PVL experienced some improvement. The two patients with diplopia and one of the two patients with blurred vision improved. Conclusion: TCZ may have a protective effect against the development of visual complications or new episodes of TVL in GCA. However, once PVL was established, only a few patients improved.

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“…Bilateral ocular involvement is another concern in these patients. Hayreh et al [2] reported that in all GCA patients with bilateral vision impairment, older changes could be found in one eye, suggesting that the patients were unaware of vision loss in one eye until the second eye was affected giving the erroneous interpretation of simultaneous bilateral ocular involvement. Thus, the estimations of the prevalence of simultaneous bilateral GCA ocular involvement suffer from the inaccuracy in the timing of the examination and perhaps were mostly imprecise and possibly preventable.…”

Section: Discussionmentioning

confidence: 99%