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Vision loss in giant cell arteritis: case-based review

Abstract

Prompt initiation of pulse glucocorticoid treatment is recommended in case of visual symptoms and suspected or proven giant cell arteritis (GCA). Pulse treatment in most cases prevents involvement of an initially unaffected fellow eye. We present the case of a biopsy-proven GCA in a 79-year-old man, complicated by sequential bilateral blindness. Initial unilateral vision loss was treated by 1 g methylprednisolone intravenously for 3 days, followed by 1 g/kg prednisone daily. Despite treatment, the second eye went completely blind 11 days after the initial vision loss. We performed a systematic search on Medline and Scopus aiming at identifying all cases of GCA complicated with loss of vision in a previously unaffected eye under pulse treatment for initially monocular vision loss. We identified 11 articles reporting 21 patients that met our inclusion criteria. Contralateral vision loss occurred 1–12 days following treatment initiation, with a median of 2 days. Treatment initiation was delayed up to 8 days since the initial vision loss, with a median delay of 2 days. Anterior ischemic optic neuropathy was the dominant mechanism of vision loss. Sequential involvement of the fellow eye in case of unilateral vision loss in GCA is rare. With 12-day interval being the longest reported, we conclude that even though the first 2 days are the most critical for the visual outcome, blindness in the initially unaffected eye may rarely occur later. Nonetheless, immediate initiation of pulse treatment remains of vital importance to preserve vision in the contralateral eye.

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Abbreviations

AAION:

Arteritic anterior ischemic optic neuropathy

ACR:

American College of Rheumatology

AION:

Anterior ischemic optic neuropathy

BCVA:

Best corrected visual acuity

BSR:

British Society of Rheumatology

CRAO:

Central retinal artery occlusion

CRP:

C-reactive protein

CVA:

Cerebrovascular accident

ESR:

Erythrocyte segmentation rate

EULAR:

European League against Rheumatism

GCA:

Giant cell arteritis

ION:

Ischemic optic neuropathy

MP:

Methylprednisolone

NAAION:

Non-arteritic anterior ischemic optic neuropathy

NLP:

No light perception

OIS:

Ocular ischemic syndrome

PION:

Posterior ischemic optic neuropathy

TAB:

Temporal artery biopsy

TCZ:

Tocilizumab

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Contributions

IK: performed the systematic search and drafted the manuscript. SA: performed the systematic search and assisted in manuscript drafting. OM: assessed the patient and assisted in manuscript drafting. DD: conceived the idea of the review, assisted in manuscript drafting and supervised the project.

Corresponding author

Correspondence to Dimitrios Daoussis.

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All the co-authors take full responsibility for the accuracy and integrity of all aspects of the work. The authors declare no conflict of interest.

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Kokloni, I.N., Aligianni, S.I., Makri, O. et al. Vision loss in giant cell arteritis: case-based review. Rheumatol Int (2022). https://doi.org/10.1007/s00296-022-05160-x

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Keywords

  • Giant cell arteritis
  • Temporal arteritis
  • Vision loss
  • Blindness
  • Pulse steroids
  • Intravenous steroids
  • Pulse glucocorticoids