Takayasu arteritis and ocular manifestations : about seven cases

Abstract

Purpose: Takayasu's arteritis (TA) is a segmental granulomatous arteritis of the aorta and its branches of unknown origin. It progresses to stenosis and occlusion of vessels affected and is life-threatening. We describe the various ocular manifestations of this arteritis in seven patients.

Methods: Patients included in this retrospective bicentric study were either monitored for checking their TA or had a revealing ocular manifestation of this arteritis. The exclusion criterion was the presence of any other condition that may explain the ocular symptoms. All patients were evaluated by a complete eye and systemic vascular examination.

Results: We included seven patients, three men and four women with a mean age of 51.1 years (range : 31-70 years). Five were already known for a TA (G1) and diagnosis could be made in two others (G2) by ophthalmological examination. We identified three typical hypoperfusion manifestations, an atypical disease (transient monocular blindness), and a steroid iatrogenic damage in G1. Eye damage was more atypical in G2 : transient monocular blindness and ischemic retinopathy complicated by bilateral central retinal artery. Treatment consisted of systemic administration of immunosuppressors and corticosteroids and secondary preventive therapy (laser photocoagulation of retinal ischemic zones). This is a small case series but the disease prevalence is low in Europe. Five cohorts describing ocular manifestations of TA have been already published. However, atypical features have not been described, probably because they are poorly known and therefore underestimated.

Conclusions: TA can cause various ocular well-known and typical late ischemic attacks, but also more unusual early inflammatory events. It should be considered in young patients with atypical vascular or inflammatory retinal manifestations. The ophthalmologist must check blood pressure and radial pulses regarding the poor prognosis of the disease. Collaboration with internists is mandatory in order to diagnose systemic involvement and to propose the best therapeutic management.

Keywords: 557 inflammation • 702 retinitis • 749 vascular occlusion/vascular occlusive disease