J Korean Ophthalmol Soc.  2017 May;58(5):600-605. 10.3341/jkos.2017.58.5.600.

A Case Report of Takayasu's Arteritis with Traction Retinal Detachment

• Lee GI
• Bae K
• Kim JM
• Kang SW

• KMID: 2378633
• DOI: http://doi.org/10.3341/jkos.2017.58.5.600

Abstract

PURPOSE
To report a rare case of traction retinal detachment and retinal ischemia in inactive Takayasu's arteritis at ophthalmologic clinic.
CASE SUMMARY
A 23-year-old woman presented with a floater, photophobia, and visual loss in her right eye one week prior to visit. She had no other systemic disease, such as diabetes mellitus or hypertension, or previous ophthalmic abnormalities except for a tumor in the adrenal gland. We found bilateral retinal ischemia and traction retinal detachment in the right eye on fundus examination without iris neovascularization. Pars plana vitrectomy, traction removal, endolaser treatment, and intravitreal bevacizumab injection were performed. Steroid eye drops and steroid systemic administration relieved the inflammation. On carotid doppler sonography, we found severe stenosis and thickness of the inner layer in both carotid arteries. We diagnosed the patient with an inactive phase of Takayasu's arteritis, which was conclusively correlated with the clinical features. Vascular anastomosis surgery along with follow-up was proposed by both the cardiology and vascular surgery departments.
CONCLUSIONS
When a young patient presents with traction retinal detachment and retinal ischemia, Takayasu's arteritis should be considered for differential diagnosis and a systemic work-up should be performed as soon as possible.

Keyword

Retinal ischemia; Takayasus arteritis; Traction retinal detachment

MeSH Terms

Adrenal Glands
Bevacizumab
Cardiology
Carotid Arteries
Constriction, Pathologic
Diabetes Mellitus
Diagnosis, Differential
Female
Follow-Up Studies
Humans
Hypertension
Inflammation
Iris
Ischemia
Ophthalmic Solutions
Photophobia
Retinal Detachment*
Retinaldehyde*
Takayasu Arteritis*
Traction*
Vitrectomy
Young Adult
Bevacizumab
Ophthalmic Solutions
Retinaldehyde

Figure

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  Figure 1 Widefield fundus photographs of right eye. (A) The image showed traction retinal detachment and vitreous hemorrhage around superior temporal and inferior temporal arcade. (B) The normal image of left eye. (C) The image showed postoperative 5 months state with flattened retina and released traction on right eye.

• 

  Figure 2 Fluorescein angiography of right eye at initial visit. (A, B) Early-phase fluorescein angiography shows delayed filling of artery. The retinal artery filling time was 20 seconds. (C) M id-phase at 1 minute 18 seconds shows numerous new vessels and leakage of fluorescent materials. The peripheral retina shows widespread capillary drop-out. (D) Late-phase at 4 minutes 39 seconds shows diffuse leakage of fluorescent material and the peripheral area appears more hyperfluorescent. (E) In left eye, we could find a new vessel superior temporal arcade area at 1 minute 2 seconds (white arrowhead). (F) Late-phase at 4 minutes 49 seconds shows peripheral diffuse leakage and hyperfluorescent features.

• 

  Figure 3 Carotid dopplersonograph of the patient. Carotid dopplersonograph shows total occlusion of right common carotid artery (black arrowhead), severe stenosis of left common carotid artery (blue arrowhead), over 70% stenosis of right subclavian artery (yellow arrowhead).

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  Figure 4 Magnetic resonance imaging of the patient. (A, B) Magnetic resonance imaging (3D TOF COW MR angiography) shows severe stenosis of right ophthalmic artery to retina against left ophthalmic artery (white arrowhead). (C) 3D-reconstructed maximal intensity projection magnetic resonance angiography shows severe stenosis of right subclavian artery (white arrowhead).

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