J Korean Ophthalmol Soc.  2016 Aug;57(8):1312-1315. 10.3341/jkos.2016.57.8.1312.

A Case of Branch Retinal Artery Occlusion Associated with Takayasu's Arteritis

• Lim JW
• Lee SU
• Lee SJ
• Nam KY

• KMID: 2349082
• DOI: http://doi.org/10.3341/jkos.2016.57.8.1312

Abstract

PURPOSE
Takayasu's arteritis generally involves the aorta and its main branch. Various ocular manifestations associated with Takayasu's arteritis have been reported, but branch retinal artery occlusion (BRAO) is very rare. We report a case of BRAO associated with Takayasu's arteritis.
CASE SUMMARY
53-year-old female patient visited out emergency room for an inferior visual field defect of the right eye that had presented 2 hours earlier. Visual acuity was 1.0 in both eyes. There were no abnormalities of the anterior segment or pupil reflex. On fundus examination, superior retinal whitening was observed in her right eye. Through ancillary study including optical coherence tomography and fluorescein angiography, she was diagnosed with BRAO and underwent conservative treatments. She had received previous treatment and had been followed-up for Takayasu's arteritis for 20 years. She complained of general weakness, and body temperature was 38.7℃. On blood analysis, erythrocyte sedimentation rate and C-reactive protein were increased compared to previous levels. She was medically treated on the assumption of relapse of Takayasu's arteritis. After 3 months, the retinal whitening in her right eye was resolved, but the visual field defect remained similar to that at the initial visit.
CONCLUSIONS
We report this rare case of BRAO associated with Takayasu's arteritis, indicating the need to consider an association between the two diseases.

Keyword

Branch retinal artery occlusion; Takayasu's arteritis

MeSH Terms

Aorta
Blood Sedimentation
Body Temperature
C-Reactive Protein
Emergency Service, Hospital
Female
Fluorescein Angiography
Humans
Middle Aged
Pupil
Recurrence
Reflex
Retinal Artery Occlusion*
Retinaldehyde
Takayasu Arteritis*
Tomography, Optical Coherence
Visual Acuity
Visual Fields
C-Reactive Protein
Retinaldehyde

Figure

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  Figure 1. Fundus photography of both eyes and optical coherence tomography of right eye at initial visit. (A) Superior retinal whitening was observed in right eye and multiple retinal hemorrhagic spots and microaneurysms was seen. (B) Superior retinal thickening was observed (white arrowhead).

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  Figure 2. Fluorescein angiography of right eye at initial visit. Delay in filling time and arteriovenous transit time of superior retinal arteries was observed and several microaneuryms were also seen.

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  Figure 3. Fundus photography and optical coherence tomography of right eye three months later. (A) Superior retinal whitening disappeared and (B) superior retinal thinning was observed at affected region (white arrowhead).

Reference

References

1. Hayreh SS, Podhajsky PA, Zimmerman MB. Retinal artery abdominal: associated systemic and ophthalmic abnormalities. abdominalogy. 2009; 116:1928–36.

2. Ryan SJ, Schachat AP, Wilkinson CP, et al. Retina. 5th ed.London: Elsevier;2013. p. 1017.

3. Brown GC, Reber R. An unusual presentation of branch retinal abdominal obstruction in association with ocular neovascularization. Can J Ophthalmol. 1986; 21:103–6.

4. Mason JC. Takayasu arteritis–advances in diagnosis and abdominal. Nat Rev Rheumatol. 2010; 6:406–15.

5. Chun YS, Park SJ, Park IK, et al. The clinical and ocular abdominal of Takayasu arteritis. Retina. 2001; 21:132–40.

6. Peter J, David S, Danda D, et al. Ocular manifestations of Takayasu arteritis: a cross-sectional study. Retina. 2011; 31:1170–8.

7. Noel N, Butel N, Le Hoang P, et al. Small vessel involvement in Takayasu's arteritis. Autoimmun Rev. 2013; 12:355–62.

8. Karam EZ, Muci-Mendoza R, Hedges TR 3rd. Retinal findings in Takayasu's arteritis. Acta Ophthalmol Scand. 1999; 77:209–13.

9. Conrath J, Hadjadj E, Serratrice J, Ridings B. Branch retinal vein occlusion reveals Takayasu's arteritis. J Fr Ophtalmol. 2004; 27:162–5.

10. Kaushik S, Gupta A, Gupta V, et al. Retinal arterial occlusion in Takayasu's arteritis. Indian J Ophthalmol. 2005; 53:194–6.

11. Das D, Mondal KK, Ray B, Chakrabarti A. A case of unusual abdominal of Takayasu's arteritis. Indian J Ophthalmol. 2010; 58:148–50.

12. Ramteke VV, Gokhale YA, Kamdar PA, et al. Sudden mono-ocular blindness with recurrent transient diplopia and ptosis in a mid-dle-aged woman. BMJ Case Rep. 2011; 2011:pii: bcr1020103414.

13. Direskeneli H, Aydin SZ, Merkel PA. Assessment of disease abdominal and progression in Takayasu's arteritis. Clin Exp Rheumatol. 2011; 29(1 Suppl 64):S86–91.

14. Skaria AM, Ruffieux P, Piletta P, et al. Takayasu arteritis and abdominal necrotizing vasculitis. Dermatology. 2000; 200:139–43.

15. Lee GY, Jang SY, Ko SM, et al. Cardiovascular manifestations of Takayasu arteritis and their relationship to the disease activity: analysis of 204 Korean patients at a single center. Int J Cardiol. 2012; 159:14–20.