Abstract Background Giant cell arteritis (GCA, temporal arteritis) is the most common primary vasculitis of adulthood. Incidence among people older than 50 years is estimated at 30/100.000 per year. Clinical symptoms are caused by end-organ ischaemia and systemic inflammation and include headache, jaw claudication, visual loss, rheumatic polymyalgia and systemic signs such as fever, fatigue and weight loss. Ocular symptoms present in 30-75% of patients and include visual loss, amaurosis fugax, ophthalmoplegia, diplopia and ocular pain. Approximately 15-50 % of patients suffer from permanent visual loss. Temporal artery biopsy and corticosteroid treatment is essential for diagnosis and preservation of vision. Methodology Review and retrospective study of 50 eyes (36 patients) with giant cell arteritis. There were 67% female and 33% male patients with average age of 79 years, range 62-92 years, with typical clinical picture and/or positive biopsy (78%, 18/23 performed). Visual fields charted by Goldmann perimeter were first categorized as peripheral defects or scotomas and further into specific categories. Results Loss of vision was unilateral (65%) or bilateral (35%). The most common ischaemic lesions were anterior ischaemic optic neuropathy (AION; 16 unilateral, 4 bilateral) and posterior ischaemic optic neuropathy (PION; 5 unilateral, 5 bilateral). Other lesions included central retinal artery occlusion and internuclear ophthalmoplegia. More than half of patients (53%) had visual acuity of counting fingers or less in affected eye. We observed 11/22 types of visual field defects according to published classification. In AION various peripheral defects, which almost universally showed respect for horizontal meridian (except where only small residual islands remained), were observed. Nasal and inferior halves of visual fields were most often affected. PION most often presented with scotomas with or without peripheral defect. Conclusions Severe loss of vision is present in affected eye in most patients. Bilateral loss of vision can occur if the diagnosis is not established early and corticosteroids given. Most common visual field defect in AION was peripheral defect with respect for horizontal meridian. PION was most often associated with central scotomas with or without peripheral defect. Very few affected eyes recover to small extent. It is essential to recognise this disease even in absence of typical signs and symptoms. In elderly, all the patients to report amaurosis fugax, sudden loss of vision or diplopia should be suspected to have temporal arteritis until proven otherwise.
Tematska oblast:
neurooftalmologija
Uvodni rad:
Da
Datum:
26.04.2012.
Br. otvaranja:
857
