Impairment of central retinal artery hemodynamics in affected and fellow eyes in giant cell arteritis patients with unilateral vision loss

Alexandre Boutigny; Nassim Mohamedi; Sarah Jeanne Pardo; Sophie Bonnin; Chahinez Ketfi; Hichem Ghaouti; Vincent Viana; Aline Frazier; Caroline Roos; Ruxandra Burlacu; Chloé Comarmond; Nathalie Kubis; Damien Sène; Philippe Bonnin

doi:10.1016/j.autrev.2023.103272

Impairment of central retinal artery hemodynamics in affected and fellow eyes in giant cell arteritis patients with unilateral vision loss

Autoimmun Rev. 2023 Mar;22(3):103272. doi: 10.1016/j.autrev.2023.103272. Epub 2023 Jan 14.

Authors

Affiliations

¹ Physiologie Clinique - Explorations Fonctionnelles, Université Paris Cité, AP-HP, Hôpital Lariboisière, F-75010 Paris, France; UMR1148 - LVTS, INSERM, Université Paris Cité, Hôpital Bichat, F-75018 Paris, France.
² Physiologie Clinique - Explorations Fonctionnelles, Université Paris Cité, AP-HP, Hôpital Lariboisière, F-75010 Paris, France.
³ Ophtalmologie, Université Paris Cité, AP-HP, Hôpital Lariboisière, F-75010 Paris, France.
⁴ Rhumatologie, Université Paris Cité, AP-HP, Hôpital Lariboisière, F-75010 Paris, France.
⁵ Urgences Céphalée, Université Paris Cité, AP-HP, Hôpital Lariboisière, F-75010 Paris, France.
⁶ Médecine interne, Université de Paris Cité, AP-HP, Hôpital Lariboisière, F-75010 Paris, France.
⁷ Physiologie Clinique - Explorations Fonctionnelles, Université Paris Cité, AP-HP, Hôpital Lariboisière, F-75010 Paris, France; UMR1148 - LVTS, INSERM, Université Paris Cité, Hôpital Bichat, F-75018 Paris, France. Electronic address: philippe.bonnin@aphp.fr.

PMID: 36649878
DOI: 10.1016/j.autrev.2023.103272

Abstract

Objectives: Permanent visual impairment is a major complication of giant cell arteritis (GCA). We investigated the added value of color Doppler imaging (CDI) of the central retinal artery (CRA) in patients with suspected GCA for early risk evaluation before temporal artery biopsy (TAB) results become available.

Methods: We conducted a non-interventional observational study of 30 consecutive patients hospitalized for suspected GCA, including a comprehensive analysis of clinical, laboratory, imaging, CDI and pathology data. GCA was diagnosed or excluded (GCA+, GCA-, respectively) according to American College of Rheumatology (ACR) criteria and TAB findings. Three patients not meeting ACR criteria were excluded secondarily. The GCA- group contained ten patients, and the GCA+ group contained 17 patients, including eight with unilateral, transient or permanent clinical visual impairment (CVI).

Results: Mean blood flow velocity (mBFV) in the CRA was impaired in the affected eyes of GCA + CVI+ patients (1.9 ± 0.9 cm.s^-1, p < 0.001) relative to controls (4.1 ± 1.0 cm.s^-1), GCA- patients (3.6 ± 0.7 cm.s^-1) and GCA + CVI- patients (3.8 ± 0.8 cm.s^-1). The mBFVs of the CRA was similar for affected and fellow eyes (right or left). CRA mBFV measurements effectively differentiated between patients with and without CVI (ROC-curve analysis, AUC = 0.925 [95%CI: 0.700 to 0.996], p < 0.0001, 88% sensitivity, 89% specificity, and cutoff of ≤2.7 cm.s^-1 for affected eyes; 75% sensitivity, 100% specificity and cutoff of ≤2.2 cm.s^-1 for fellow eyes).

Conclusion: CDI facilities the early detection of visual ischemia risk in GCA+ patients, justifying urgent high-dose corticosteroid administration to save at least the fellow eye before pathology results become available.

Keywords: Arteritic anterior ischemic optic neuropathy; Central retinal artery; Central retinal artery occlusion; Color Doppler imaging; Diagnostic marker; Giant cell arteritis; Horton disease; Vision loss; Visual impairment.

Publication types

Review

MeSH terms

Biopsy
Eye / pathology
Giant Cell Arteritis* / complications
Giant Cell Arteritis* / diagnosis
Giant Cell Arteritis* / pathology
Hemodynamics
Humans
Retinal Artery* / pathology
Retrospective Studies
Vision Disorders