Giant Cell Arteritis Presenting With Ocular Symptoms: Clinical Characteristics and Multimodal Imaging in a Chinese Case Series
PurposeTo evaluate demographic and clinical characteristics of a Chinese population with giant cell arteritis using multimodal imaging focusing on ophthalmic examinations.DesignRetrospective observational case series.Materials and MethodsIn the neuro-ophthalmology division of the Eye, Ear, Nose, and...
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.885463/full |
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| author | Qian Chen Weimin Chen Chaoyi Feng Deshan Gong Jiong Zhang Yingwen Bi Ping Sun Xinghuai Sun Xinghuai Sun Guohong Tian Guohong Tian |
| author_facet | Qian Chen Weimin Chen Chaoyi Feng Deshan Gong Jiong Zhang Yingwen Bi Ping Sun Xinghuai Sun Xinghuai Sun Guohong Tian Guohong Tian |
| author_sort | Qian Chen |
| collection | DOAJ |
| description | PurposeTo evaluate demographic and clinical characteristics of a Chinese population with giant cell arteritis using multimodal imaging focusing on ophthalmic examinations.DesignRetrospective observational case series.Materials and MethodsIn the neuro-ophthalmology division of the Eye, Ear, Nose, and Throat Hospital, Shanghai, we evaluated the demographic and clinical characteristics of patients diagnosed with giant cell arteritis between January 2016 and June 2021. Results of routine ophthalmic examinations including fundus examination, optical coherence tomography, color duplex ultrasonography of ocular and superficial temporal arteries, orbital magnetic resonance imaging, and superficial temporal artery biopsy were evaluated.ResultsA total of 15 patients (22 eyes; ten male and five female) were evaluated with a mean age of 77.0 ± 8.5 years. Among them, seven had bilateral involvement that occurred simultaneously or sequentially. Twelve patients presented with arteritic anterior ischemic optic neuropathy, two with arteritic anterior ischemic optic neuropathy combined with cilioretinal artery occlusion, and one with cotton-wool spots. In acute stages of optic neuropathy and retinopathy, optical coherence tomography revealed optic disc edema, thickening of the inner retinal nerve fiber layer and ganglion cell layer, and loss of layer structure. In late stages, optical coherence tomography revealed diffuse atrophy of the inner retina. The “halo” sign was observed in 12 patients in the superficial temporal artery ultrasound, and seven out of eight patients who underwent biopsy demonstrated classic giant cell arteritis pathological changes. Most patients having poor visual acuity but ability to perceive light; 10/22 eyes had permanent vision loss.ConclusionAlthough rare in Asians, giant cell arteritis may be underdiagnosed among elderly Chinese patients presenting with anterior ischemic optic neuropathy. Non-invasive superficial temporal artery ultrasound detecting inflammatory thickening of the intima as the “halo” sign combined with routine elevated erythrocyte sedimentation rate and C-reactive protein may be helpful in diagnosing patients with a high probability of having giant cell arteritis. |
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| language | English |
| last_indexed | 2024-12-12T03:46:59Z |
| publishDate | 2022-06-01 |
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| series | Frontiers in Medicine |
| spelling | doaj.art-6aa93041c0bf4fea975084033aad51242022-12-22T00:39:30ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-06-01910.3389/fmed.2022.885463885463Giant Cell Arteritis Presenting With Ocular Symptoms: Clinical Characteristics and Multimodal Imaging in a Chinese Case SeriesQian Chen0Weimin Chen1Chaoyi Feng2Deshan Gong3Jiong Zhang4Yingwen Bi5Ping Sun6Xinghuai Sun7Xinghuai Sun8Guohong Tian9Guohong Tian10Department of Ophthalmology, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai, ChinaDepartment of Neurology, Shanghai Deji Hospital, Shanghai, ChinaDepartment of Ophthalmology, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai, ChinaDepartment of Neurosurgery, Shanghai Deji Hospital, Shanghai, ChinaDepartment of Rheumatology, Huashan Hospital, Fudan University, Shanghai, ChinaDepartment of Ophthalmology, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai, ChinaDepartment of Ophthalmology, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai, ChinaDepartment of Ophthalmology, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai, ChinaState Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Fudan University, Shanghai, ChinaDepartment of Ophthalmology, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai, ChinaState Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Fudan University, Shanghai, ChinaPurposeTo evaluate demographic and clinical characteristics of a Chinese population with giant cell arteritis using multimodal imaging focusing on ophthalmic examinations.DesignRetrospective observational case series.Materials and MethodsIn the neuro-ophthalmology division of the Eye, Ear, Nose, and Throat Hospital, Shanghai, we evaluated the demographic and clinical characteristics of patients diagnosed with giant cell arteritis between January 2016 and June 2021. Results of routine ophthalmic examinations including fundus examination, optical coherence tomography, color duplex ultrasonography of ocular and superficial temporal arteries, orbital magnetic resonance imaging, and superficial temporal artery biopsy were evaluated.ResultsA total of 15 patients (22 eyes; ten male and five female) were evaluated with a mean age of 77.0 ± 8.5 years. Among them, seven had bilateral involvement that occurred simultaneously or sequentially. Twelve patients presented with arteritic anterior ischemic optic neuropathy, two with arteritic anterior ischemic optic neuropathy combined with cilioretinal artery occlusion, and one with cotton-wool spots. In acute stages of optic neuropathy and retinopathy, optical coherence tomography revealed optic disc edema, thickening of the inner retinal nerve fiber layer and ganglion cell layer, and loss of layer structure. In late stages, optical coherence tomography revealed diffuse atrophy of the inner retina. The “halo” sign was observed in 12 patients in the superficial temporal artery ultrasound, and seven out of eight patients who underwent biopsy demonstrated classic giant cell arteritis pathological changes. Most patients having poor visual acuity but ability to perceive light; 10/22 eyes had permanent vision loss.ConclusionAlthough rare in Asians, giant cell arteritis may be underdiagnosed among elderly Chinese patients presenting with anterior ischemic optic neuropathy. Non-invasive superficial temporal artery ultrasound detecting inflammatory thickening of the intima as the “halo” sign combined with routine elevated erythrocyte sedimentation rate and C-reactive protein may be helpful in diagnosing patients with a high probability of having giant cell arteritis.https://www.frontiersin.org/articles/10.3389/fmed.2022.885463/fullgiant cell arteritis (GCA)anterior ischemic optic neuropathy (AION)arteritic anterior ischemic optic neuropathycolor duplex ultrasonographysuperficial temporal artery biopsy |
| spellingShingle | Qian Chen Weimin Chen Chaoyi Feng Deshan Gong Jiong Zhang Yingwen Bi Ping Sun Xinghuai Sun Xinghuai Sun Guohong Tian Guohong Tian Giant Cell Arteritis Presenting With Ocular Symptoms: Clinical Characteristics and Multimodal Imaging in a Chinese Case Series Frontiers in Medicine giant cell arteritis (GCA) anterior ischemic optic neuropathy (AION) arteritic anterior ischemic optic neuropathy color duplex ultrasonography superficial temporal artery biopsy |
| title | Giant Cell Arteritis Presenting With Ocular Symptoms: Clinical Characteristics and Multimodal Imaging in a Chinese Case Series |
| title_full | Giant Cell Arteritis Presenting With Ocular Symptoms: Clinical Characteristics and Multimodal Imaging in a Chinese Case Series |
| title_fullStr | Giant Cell Arteritis Presenting With Ocular Symptoms: Clinical Characteristics and Multimodal Imaging in a Chinese Case Series |
| title_full_unstemmed | Giant Cell Arteritis Presenting With Ocular Symptoms: Clinical Characteristics and Multimodal Imaging in a Chinese Case Series |
| title_short | Giant Cell Arteritis Presenting With Ocular Symptoms: Clinical Characteristics and Multimodal Imaging in a Chinese Case Series |
| title_sort | giant cell arteritis presenting with ocular symptoms clinical characteristics and multimodal imaging in a chinese case series |
| topic | giant cell arteritis (GCA) anterior ischemic optic neuropathy (AION) arteritic anterior ischemic optic neuropathy color duplex ultrasonography superficial temporal artery biopsy |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.885463/full |
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