Headache and Whiteout Vision as the Presenting Symptoms in a Case of Takayasu Retinopathy

Lee, Jennifer C.; Wang, Michelle; Damodar, Dhanur; Sadun, Alfredo A.; Sadda, Srinivas R

doi:10.1097/icb.0000000000000091

Cited by 9 publications

(5 citation statements)

References 3 publications

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“…Among them, 2 were written in Chinese (6 patients) (18,25), and the remaining 47 (59 patients) were published in English. Included studies were published between 1957 and 2021, the types of which were case reports (40 articles) (7,8,16,17,19,, case series (7 articles) (3,17,18,20,(59)(60)(61), and image-based articles (2 articles) (21,62). The methodological quality assessment showed that 8 studies were of good quality, 33 studies were of moderate quality, and 8 studies were of poor quality (Supplementary Table 1).…”

Section: Literature Search Resultsmentioning

confidence: 99%

“…Compared with open surgery, angioplasty with or without stent is a less invasive and safe method, especially for short-segment lesions (15). Over the past decades, sporadic case reports have addressed ocular outcomes in surgery-treated TA patients (16)(17)(18)(19). A recent case-series study (20) specifically reported the efficacy of endovascular stenting in TR patients.…”

Section: Introductionmentioning

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: Literature Search Resultsmentioning

confidence: 99%

Section: Introductionmentioning

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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“…Supplementary material 4 gives details of the studies included for analysis of various parameters. [ 2 3 5 6 7 8 11 12 13 14 15 17 18 19 20 26 29 30 31 32 33 34 35 36 38 39 40 41 42 44 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 65 66 68 69 70 71 72 74 75 76 77 78 83 84 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 10 ] In addition to the age and effect of steroids, the circulatory alterations causing diminished lens nutrition, metabolic changes, and possibly neuroreceptor derangement favor cataract formation. [ 10 11 12 ] Findings such as iris atrophy, anterior chamber (AC) flare, and intraoperative incalcitrant hyphema in the absence of neovascularization at the iris or angle indicate chronic anterior segment ischemia causing early cataract changes. [ 10 ]…”

mentioning

confidence: 99%

Posterior segment manifestations of Takayasu arteritis: A narrative review

Sharma,

Rishi,

Rishi

et al. 2024

Indian Journal of Ophthalmology

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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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“…7 Ocular symptoms are also vague and includes amaurosis fugax, visual disturbances, subjective reduction in vision, or patients may be asymptomatic. [8][9] Approximately 25.7% of patients with Takayasu arteritis experiences amaurosis fugax. 10 As the disease advances, a decrease in intraocular pressure may also be noted.…”

Section: Signs/symptomsmentioning

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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Headache and Whiteout Vision as the Presenting Symptoms in a Case of Takayasu Retinopathy

Cited by 9 publications

References 3 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

Posterior segment manifestations of Takayasu arteritis: A narrative review

Collateral Damage: A Differential of Takayasu Retinopathy

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