Limits...
Anterior ischemic optic neuropathy due to biopsy-proven giant cell arteritis in Thai patients.

Attaseth T, Vanikieti K, Poonyathalang A, Preechawat P, Jindahra P, Wattanatranon D - Clin Ophthalmol (2015)

Bottom Line: Demographic data, clinical manifestations, laboratory findings, treatment, and visual outcome are described in detail and compared with Caucasian patients.We found no differences in any clinical features except for sex preference.Moreover, perioptic nerve sheath enhancement was observed in half of our patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Mahidol University, Bangkok, Thailand.

ABSTRACT
Giant cell arteritis is a systemic granulomatous vasculitis affecting medium to large arteries. An arteritic anterior ischemic optic neuropathy is the most common cause of permanent visual loss. Giant cell arteritis is very rare among Asians. We report six patients with biopsy-proven arteritic anterior ischemic optic neuropathy. Demographic data, clinical manifestations, laboratory findings, treatment, and visual outcome are described in detail and compared with Caucasian patients. We found no differences in any clinical features except for sex preference. Moreover, perioptic nerve sheath enhancement was observed in half of our patients.

No MeSH data available.


Related in: MedlinePlus

Post contrast axial and coronal T1-weighted magnetic resonance imaging with fat suppression shows perineural enhancement of both optic nerves and orbital fat enhancement in patient 1 (A, B) and patient 3 (C, D).
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4472068&req=5

f3-opth-9-1071: Post contrast axial and coronal T1-weighted magnetic resonance imaging with fat suppression shows perineural enhancement of both optic nerves and orbital fat enhancement in patient 1 (A, B) and patient 3 (C, D).

Mentions: Of the six patients with biopsy-proven GCA, two had bilateral, simultaneous onset of A-AION and four had unilateral involvement (eight eyes in total). In the unilateral A-AION group, two patients developed contralateral visual loss from cilioretinal artery occlusion 2 weeks before the onset of A-AION. All eyes had severe visual loss (20/200 or worse) at initial presentation. No light perception was detected in three eyes. The mean duration of visual loss was 8.2 days, ranging from 1 day to 17 days. Optic discs appeared diffusely swollen and pale in all patients (Figure 1). Neither peri-papillary hemorrhages nor exudates were found. Retinal cotton wool spots were identified in three eyes (two patients). One patient experienced ipsilateral transient monocular visual loss prior to the onset of A-AION. Systemic symptoms were present before and at the time of visual loss in three patients (50%). These included headache and at least one of the following symptoms: scalp tenderness, jaw claudication, fever and general malaise, and anorexia and weight loss. Abnormal superficial temporal arteries were found during examination in three cases. No patients complained of diplopia. Fundus fluorescein angiography and indocyanine green angiography were performed in four patients. Delayed choroidal filling time was demonstrated in all, whereas, choroidal non-perfusion was found in one patient (Figure 2). MRIs of orbit and brain were performed in five patients. Abnormal MRI findings were shown in three patients (Figure 3). Perineural enhancement of the intraorbital part of the optic nerves was observed in these three patients. Their optic nerve signals were normal. Stranding of bilateral intraorbital fat was also identified. Diffuse weighted image sequences performed in two patients with abnormal MRI findings were unremarkable. There were no imaging signs of cerebral vasculitis in any of the patients. The mean ESR was 95 mm/hr (75–102 mm/hr). CRP was high in four patients, (17–122 mg/L). There were four patients with anemia and two patients with thrombocytosis.


Anterior ischemic optic neuropathy due to biopsy-proven giant cell arteritis in Thai patients.

Attaseth T, Vanikieti K, Poonyathalang A, Preechawat P, Jindahra P, Wattanatranon D - Clin Ophthalmol (2015)

Post contrast axial and coronal T1-weighted magnetic resonance imaging with fat suppression shows perineural enhancement of both optic nerves and orbital fat enhancement in patient 1 (A, B) and patient 3 (C, D).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4472068&req=5

f3-opth-9-1071: Post contrast axial and coronal T1-weighted magnetic resonance imaging with fat suppression shows perineural enhancement of both optic nerves and orbital fat enhancement in patient 1 (A, B) and patient 3 (C, D).
Mentions: Of the six patients with biopsy-proven GCA, two had bilateral, simultaneous onset of A-AION and four had unilateral involvement (eight eyes in total). In the unilateral A-AION group, two patients developed contralateral visual loss from cilioretinal artery occlusion 2 weeks before the onset of A-AION. All eyes had severe visual loss (20/200 or worse) at initial presentation. No light perception was detected in three eyes. The mean duration of visual loss was 8.2 days, ranging from 1 day to 17 days. Optic discs appeared diffusely swollen and pale in all patients (Figure 1). Neither peri-papillary hemorrhages nor exudates were found. Retinal cotton wool spots were identified in three eyes (two patients). One patient experienced ipsilateral transient monocular visual loss prior to the onset of A-AION. Systemic symptoms were present before and at the time of visual loss in three patients (50%). These included headache and at least one of the following symptoms: scalp tenderness, jaw claudication, fever and general malaise, and anorexia and weight loss. Abnormal superficial temporal arteries were found during examination in three cases. No patients complained of diplopia. Fundus fluorescein angiography and indocyanine green angiography were performed in four patients. Delayed choroidal filling time was demonstrated in all, whereas, choroidal non-perfusion was found in one patient (Figure 2). MRIs of orbit and brain were performed in five patients. Abnormal MRI findings were shown in three patients (Figure 3). Perineural enhancement of the intraorbital part of the optic nerves was observed in these three patients. Their optic nerve signals were normal. Stranding of bilateral intraorbital fat was also identified. Diffuse weighted image sequences performed in two patients with abnormal MRI findings were unremarkable. There were no imaging signs of cerebral vasculitis in any of the patients. The mean ESR was 95 mm/hr (75–102 mm/hr). CRP was high in four patients, (17–122 mg/L). There were four patients with anemia and two patients with thrombocytosis.

Bottom Line: Demographic data, clinical manifestations, laboratory findings, treatment, and visual outcome are described in detail and compared with Caucasian patients.We found no differences in any clinical features except for sex preference.Moreover, perioptic nerve sheath enhancement was observed in half of our patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Mahidol University, Bangkok, Thailand.

ABSTRACT
Giant cell arteritis is a systemic granulomatous vasculitis affecting medium to large arteries. An arteritic anterior ischemic optic neuropathy is the most common cause of permanent visual loss. Giant cell arteritis is very rare among Asians. We report six patients with biopsy-proven arteritic anterior ischemic optic neuropathy. Demographic data, clinical manifestations, laboratory findings, treatment, and visual outcome are described in detail and compared with Caucasian patients. We found no differences in any clinical features except for sex preference. Moreover, perioptic nerve sheath enhancement was observed in half of our patients.

No MeSH data available.


Related in: MedlinePlus