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E. Heron, A. Affortit-Demoge, I. Rossignol, N. Sedira, S. Feldman-Billard; Six-Year Results of a Protocol for the Early Diagnosis of Temporal Arteritis in an Ophthalmological Setting. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4019.
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Preventing ocular complications remain the main goal of the treatment of temporal arteritis (TA). We reviewed our last 6-year experience of TA-related ocular manifestations at a national eye center, and of our diagnostic strategy for TA.
Retrospective study of medical records: since august 2001, all patients with ischemic ocular manifestations potentially related to TA had C-reactive protein and erythrocyte sedimentation rate measured in emergency, their ocular and general manifestations were recorded by an internist. Patients older than 55 years with acute anterior ischemic optic neuropathy (AAION) systematically had temporal artery biopsy, whereas those with other ocular manifestations qualified for a biopsy in the presence of systemic signs and/or laboratory abnormalities. The diagnosis of TA was based on histological signs, or in presence of a high level of clinical and/or biological suspicion.
Between august 2001 and september 2007, a temporal artery biopsy was done in 305 patients, 265 of them (87%) with AAION. A diagnosis of TA was made in 82 patients (27%), biopsy-proven in 59 of them (72%) and despite a negative biopsy in 23 (28%). Among these 82 patients, 71 (86%) had a definitive vision loss due to AAION in 67 (82%) and to central retinal artery occlusion in 4 (5%), whereas 11 (13%) had only transient ocular manifestations (6 had diplopia and 5 had transient monocular blindness) which didn't progress to a definitive vision loss after steroid treatment (pulse methylprednisolone). Among patients with AAION, a positive biopsy was obtained in 47 cases, of whom 11 (23%) had occult TA (no systemic sign or symptom) and 3 (6%) had normal laboratory parameters before steroid treatment.
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