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Bilateral Choroidal Ischemia in Giant Cell Arteritis

Bilateral Choroidal Ischemia in Giant Cell Arteritis A 71-year-old woman experienced vision loss for 2 weeks in her right eye along with jaw pain, headache, fevers, and malaise. Her visual acuity was 20/200 OD and 20/30 OS. She had a right afferent pupillary defect. Findings from her fundus examination were normal except for rare cotton-wool spots (Figure 1). Her blood pressure was normal. A fluorescein angiogram revealed delayed choroidal filling in both eyes (Figure 2 and Figure 3). She was immediately started on therapy with high-dose oral prednisone. Results from temporal artery biopsy were positive. One month later, her visual acuity had improved to 20/40 OD and 20/30 OS. Figure 1. View LargeDownload Fundus photographs showing cotton-wool spots in both eyes. There are no retinal vascular occlusions and there is no optic disc swelling. Figure 2. View LargeDownload Laminar phase fluorescein angiogram of the right eye. Dark areas are regions of choroidal ischemia. This eye eventually had complete filling of the choroid at 100 seconds. Figure 3. View LargeDownload Venous phase fluorescein angiogram of the left eye. Dark areas are regions of choroidal ischemia. Even at 4 minutes, the temporal choroid did not fill. The eye eventually developed hyperpigmentation in the area of nonperfusion. Comment Although isolated choroidal ischemia without a retinal vascular occlusion or optic nerve swelling is a rare manifestation of giant cell arteritis,1 its presence warrants testing for this treatable, serious disease, especially in a normotensive elderly patient. Correspondence: Steven M. Cohen, MD, 579 S Duncan Ave, Clearwater, FL 33756 (scohen@hsc.usf.edu). Financial Disclosure: None. References 1. Quillen DACantore WASchwartz SR et al. Choroidal nonperfusion in giant cell arteritis. Am J Ophthalmol 1993;116171- 175PubMedGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Bilateral Choroidal Ischemia in Giant Cell Arteritis

Archives of Ophthalmology , Volume 124 (6) – Jun 1, 2006

Bilateral Choroidal Ischemia in Giant Cell Arteritis

Abstract

A 71-year-old woman experienced vision loss for 2 weeks in her right eye along with jaw pain, headache, fevers, and malaise. Her visual acuity was 20/200 OD and 20/30 OS. She had a right afferent pupillary defect. Findings from her fundus examination were normal except for rare cotton-wool spots (Figure 1). Her blood pressure was normal. A fluorescein angiogram revealed delayed choroidal filling in both eyes (Figure 2 and Figure 3). She was immediately started on therapy with high-dose oral...
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References (1)

Publisher
American Medical Association
Copyright
Copyright © 2006 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.124.6.922
Publisher site
See Article on Publisher Site

Abstract

A 71-year-old woman experienced vision loss for 2 weeks in her right eye along with jaw pain, headache, fevers, and malaise. Her visual acuity was 20/200 OD and 20/30 OS. She had a right afferent pupillary defect. Findings from her fundus examination were normal except for rare cotton-wool spots (Figure 1). Her blood pressure was normal. A fluorescein angiogram revealed delayed choroidal filling in both eyes (Figure 2 and Figure 3). She was immediately started on therapy with high-dose oral prednisone. Results from temporal artery biopsy were positive. One month later, her visual acuity had improved to 20/40 OD and 20/30 OS. Figure 1. View LargeDownload Fundus photographs showing cotton-wool spots in both eyes. There are no retinal vascular occlusions and there is no optic disc swelling. Figure 2. View LargeDownload Laminar phase fluorescein angiogram of the right eye. Dark areas are regions of choroidal ischemia. This eye eventually had complete filling of the choroid at 100 seconds. Figure 3. View LargeDownload Venous phase fluorescein angiogram of the left eye. Dark areas are regions of choroidal ischemia. Even at 4 minutes, the temporal choroid did not fill. The eye eventually developed hyperpigmentation in the area of nonperfusion. Comment Although isolated choroidal ischemia without a retinal vascular occlusion or optic nerve swelling is a rare manifestation of giant cell arteritis,1 its presence warrants testing for this treatable, serious disease, especially in a normotensive elderly patient. Correspondence: Steven M. Cohen, MD, 579 S Duncan Ave, Clearwater, FL 33756 (scohen@hsc.usf.edu). Financial Disclosure: None. References 1. Quillen DACantore WASchwartz SR et al. Choroidal nonperfusion in giant cell arteritis. Am J Ophthalmol 1993;116171- 175PubMedGoogle Scholar

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Jun 1, 2006

Keywords: ischemia,giant cell arteritis

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