Ocular Manifestations in an Italian Cohort of Patients with Takayasu Arteritis.

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.

A case of anti-VEGF therapy application in Takayasu arteries with retinopathy.

PURPOSE: Takayasu arteritis (TA) is a systemic granulomatous large vessel vasculitis that involves mainly the aorta and its primary branches, and occurs most commonly in young females. Ocular manifestations of TA include small vessels dilation, microaneurysm, arteriovenous anastomosis, retinal ischemia and retinopathy. However, no specific and effective treatments for Takayasu retinopathy is applied. This case aimed to demonstrate the role of anti-VEGF (vascular endothelial growth factor) therapy in treating Takayasu retinopathy. OBSERVATIONS: We herein reported an 18-year-old Asian woman who presented with typical wreath-like arteriovenous anastomosis around the disc in the right eye and vitreous hemorrhage in the left eye. The stenosis and occlusion of bilateral subclavian arteries, carotid arteries and other proximal arteries on angiography confirmed the diagnosis of TA. Meanwhile, elevated ESR and CRP revealed that TA was in the active stage. We applied anti-VEGF therapy in treating Takayasu retinopathy specially to inhibit neovascularization. Additionally, vitreous extraction was conducted in the left eye after the treatment of anti-VEGF therapy. CONCLUSIONS AND IMPORTANCE: This is the first report of effective application of anti-VEGF therapy in inhibiting wreath-like arteriovenous anastomosis and improving vitrectomy in TA.

Takayasu's arteritis: Ischaemic retinal arterial occlusion as a possible initial presentation. / Arteritis de Takayasu: obstrucción arterial retiniana isquémica como posible presentación inicial.

Ocular manifestations are observed in 25% of patients with Takayasu's arteritis. Its signs and symptoms can be very variable. The case is presented of a 41-year-old woman with progressive vision loss in her right eye secondary to ischaemic retinal arterial occlusion. After a systematic study, a protein purified derivative (PPD) skin test compatible with tuberculosis was found to be the only alteration. After ruling out other causes, and based on the initial suspicion of tuberculous retinal vasculitis, treatment was started with antimicrobial agents and systemic corticosteroids, without any therapeutic response. Eighteen months later, the patient developed acute kidney failure, secondary to right renal artery stenosis. The CT-angiography revealed a thickening of the aortic arch and its branches, and Takayasús arteritis was finally diagnosed. Therefore, emphasis is made on the importance of the ophthalmologist in the diagnosis of Takayasús arteritis, in which its ophthalmological manifestations can be an early sign of the disease.

Fluorescein and OCT Angiography Features of Takayasu Disease.

Purpose: Evaluate OCT (optical coherence tomography) angiography (OCTA) features in patients with Takayasau disease. Methods: The OCTA was analyzed to evaluate perifoveal anastomatic capillary arcade disruption, microaneurysms. The foveal avascular zone (FAZ) was measured for superficial (SCP) and deep capillary plexus. Results: There were 26 eyes included. In OCTA, 11 eyes presented ruptures of the perifoveal anastomotic capillary arcade in SCP. A total of 5 had microaneurysms. The average SCP FAZ was increased to 0.34 mm2 in Takayasu compared to 0.27 mm2 in control patients. Conclusion: Fluorescein angiography is the gold standard to describe Takayasu retinopathy ischemic signs. Macular abnormalities are uncommon in Takayasu patients as retinopathy signs are mostly located in peripheral retina. This study reveals that most of our patients present an enlargement of the FAZ then highlights the relevance of OCTA to evaluate macular ischemia as a complement to usual retina global study in fluorescein angiography.

Painless bilateral visual loss in a 33-year-old woman with severe arterial hypotension.

A 32-year-old woman experienced dizziness and headache for 5 months. She also complained of painless, progressive bilateral visual loss for several weeks. Before developing the initial symptoms, she had an uncomplicated pregnancy except for dizziness and systemic hypotension during the first term. Fundus examination disclosed prominent retinal arteries as well diffuse microaneurysms, widespread intraretinal hemorrhages, and hyperemic optic disks. Brain magnetic resonance imaging revealed multiple supratentorial white-matter lesions suggestive of ischemic strokes. Initially, she had severe systemic hypotension (41/17 mm Hg). When reassessed, blood pressure was normal in the lower limbs, but there was severe hypotension in the upper limbs. An angio-computed tomography of the supraortic trunks showed occlusion of both primitive carotid arteries, both subclavian arteries and the right axillary and humeral arteries. Based on these findings, the diagnosis of Takayasu type-I arteritis with ischemic retinopathy and cerebrovascular disease was established. Bilateral retinal panphotocoagulation and aorta to right carotid bypass were performed because of the severity of the ischemic lesions.

Arteritis de Takayasu / Takayasu's arteritis

Presentamos el caso de una paciente de 28 años quien consulta a nuestra clínica por pérdida bilateral y crónica de la visión y episodios de síncope de reciente aparición. No tenía historia de síntomas sistémicos o debidos a disminución del flujo sanguíneo en las extremidades. Durante la hospitalización se encuentra déficit de pulso en las extremidades superiores. La arteriografía muestra estenosis severa de ambas arterias subclavias, carótidas comunes y la arteria vertebral derecha. Se hizo un diagnóstico de arteritis de Takayasu. Se presenta una revisión corta de la patología (Acta Med Colomb 2011; 36: 93-97).

We describe the case of a 28-year-old woman who presented to our clinic with a history of chronic bilateral visual loss and recent episodes of syncope. She did not have a history of systemic symptoms or manifestations of reduced blood flow in her limbs. During her hospital stay, deficient pulses were discovered in both arms. Once hospitalized the physician discloses a pulse deficit in both arms. Angiographic studies showed severe bilateral stenosis of the subclavian and carotid arteries and of the right vertebral artery. The diagnosis of Takayasu's arteritis was confirmed. A brief review of this disease is presented in this paper (Acta Med Colomb 2011; 36: 93-97).

A Case Report of Takayaeu's Arteritis Associated with, a Retinopathy

The authors have experienced a case of Takayasu's arteritis associated with Takayasu's retinopathy which is confirmed by aortography and fluorescent angiography in a 14 year old female.