Choroidal ischemia as one cardinal sign in giant cell arteritis

Antonio M B Casella; Ahmad M Mansour; Souza Ec; Rodrigo B do Prado; Rodrigo Meirelles; Keye Wong; Salma Yassine; Mário Luiz R Monteiro

doi:10.1186/s40942-022-00422-z

Choroidal ischemia as one cardinal sign in giant cell arteritis

Int J Retina Vitreous. 2022 Sep 24;8(1):69. doi: 10.1186/s40942-022-00422-z.

Authors

Antonio M B Casella¹, Ahmad M Mansour², Souza Ec³, Rodrigo B do Prado⁴, Rodrigo Meirelles⁵, Keye Wong⁶, Salma Yassine⁷, Mário Luiz R Monteiro³

Affiliations

¹ Department of Surgery, Health Sciences Center, Londrina State University, 60 Robert Koch Av 86038, Londrina, Paraná, Brazil. mbcasella@gmaill.com.
² Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.
³ Division of Ophthalmology, University of São Paulo, São Paulo, Brazil.
⁴ Department of Surgery, Health Sciences Center, Londrina State University, 60 Robert Koch Av 86038, Londrina, Paraná, Brazil.
⁵ Piracicaba Ophthalmological Institute, Piracicaba, São Paulo, Brazil.
⁶ Retina Associates of Sarasota, Sarasota, FL, USA.
⁷ Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota, USA.

Abstract

Purpose: To describe chorioretinal signs in a case series of Giant Cell Arteritis (GCA).

Methods: This is a multicenter retrospective observational case series with GCA that presented with a headache and an abrupt, unilateral loss in vision. Workup included temporal artery biopsies, intravenous fluorescein angiography, optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), blood levels of erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).

Results: There are a total of 8 GCA instances presented. Average age was 74.5. (Range 68-83 years). The patients reported that one eye's visual loss had suddenly started, along with a fresh headache and other systemic symptoms. Eight patients exhibited choroidal ischemia, five paracentral acute middle maculopathy (PAMM) lesions, five cotton wool spots, four anterior ischemic optic neuropathy, and one central retinal arterial occlusion at the time of presentation. The average ESR at presentation was 68 mm/hr (range 4-110), and 4/6 individuals had a significant increase. The mean CRP level was 6.2 mg/dL (range 2.0-15.4), and the level was always over the normal range. All patients' temporal artery biopsies were positive.

Conclusion: Alongside PAMM lesions, cotton wool spots, anterior ischemic optic neuropathy, and central retinal artery occlusion, choroidal ischemia is a key angiographic indicator in the diagnosis of GCA. It may be crucial to recognize these typical ischemic chorioretinal signs while diagnosing GCA.

Keywords: Arteritic anterior ischemic optic neuropathy; Choroidal hypoperfusion; Cotton-wool spots; Fluorescein angiography; Giant cell arteritis; OCTA; Paracentral acute middle maculopathy.