|Ahead of print publication
Look beyond the eye: A rare case of retinal neovascularization in Takayasu arteritis
Divyalakshmi Kaiyoor Surya, Cynthia Arunachalam
Department of Ophthalmology, Yenepoya Medical College, Mangalore, Karnataka, India
|Date of Submission||19-May-2020|
|Date of Acceptance||27-Jun-2020|
Divyalakshmi Kaiyoor Surya,
Department of Ophthalmology, Yenepoya Medical College, Mangalore - 575 018, Karnataka
Source of Support: None, Conflict of Interest: None
A young 18-year-old girl presented with gradually painless progressive diminution of vision in the left eye for 4 months. Her best-corrected visual acuity was 6/36 Left eye. Clinical examination showed anterior segment ischemia and extensive peripheral retinal avascularity with neovascularization. Fundus fluorescein angiography confirmed the findings of ischemia with nonperfusion. Systemic evaluation showed feeble upper limb pulses and nonrecordable blood pressure. Computed tomography angiogram showed signs of inflammatory aortitis involving the left common carotid artery. All the findings were consistent with Takayasu arteritis. The patient was treated with systemic immunosuppressant and showed good response to therapy with regression of neovascularization.
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Keywords: Neovascularisation, Ocular ischemia, Takayasu arteritis, Ocular ischemia, Takayasu arteritis
| Introduction|| |
Takayasu arteritis is a large vessel vasculitis affecting the aorta and its primary branches. Women are affected in 80%–90% of cases, with an age of onset being 10–40 years., Symptoms of vascular damage due to vasculitis present late in the course of the disease. Ocular symptoms are rarely the presenting features and features of ocular ischemia, with neovascularization being very rare. We report a case of a young lady who presented with ocular ischemia and neovascularization and was later diagnosed to have Takayasu arteritis.
| Case Report|| |
Eighteen year old female presented with diminution of vision in Left eye for 4 months. She also gave a history of fever and giddiness a few months back. On examination her best corrected visual acuity in right eye (Right eye) was 6/12 and in Left eye (Left eye) was 6/36. Anterior segment in right eye was normal with intraocular pressure (IOP) 12 mmH. Left eye showed + 2 flare, cells, dilated fixed pupils, and IOP of 8 mmHg. Fundoscopy showed segmentation of blood column in retinal arterioles in oculus dextrus that is Right eye (right eye). Left eye showed neovascularization of the optic disc with totally avascular periphery [Figure 1]a and [Figure 1]b. Fluorescein angiogram showed right eye-multiple microaneurysms with disc leak. Left eye showed delayed arm retina time, patchy choroidal fluorescence, delayed A-V transit time, and extensive retinal hypoperfusion [Figure 2]a, [Figure 2]b, [Figure 2]c, [Figure 2]d. Systemic examination and investigations revealed feeble upper limb pulses, nonrecordable upper limb BP, and a systolic murmur. Computed tomography angiogram showed signs of inflammatory aortitis involving the left common carotid artery which was consistent with Takayasu arteritis. She was treated with pulse IV methylprednisolone 750 mg, followed by oral steroids 1 mg/kg with oral azathioprine 25 mg right eye. Dramatic response with regression of disc new vessels was noted at 1 month [Figure 3].
|Figure 1: Right eye (a) Segmentation of blood column (white) Left eye (b) Neovascularisation of optic disc (black) and peripheral avascularity (white dotted)|
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|Figure 2: (a and b) right eye fundus fluorescein angiography-Mild disc leak (white) and multiple microaneurysms (dotted white). (c and d): Left eye fundus fluorescein angiography-patchy choroidal fluorescence (white) and extensive peripheral nonperfusion with disc leak (dotted white)|
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| Discussion|| |
Ocular manifestations of Takayasu arteritis include Takayasu retinopathy, hypertensive retinopathy, and rarely, ocular ischemia. Ocular ischemia is due to hypoperfusion by the ophthalmic artery resulting due to vasculitis of primary branches of the aorta. Ocular ischemia as a presenting feature of Takayasu arteritis has been reported very rarely. Our patient presented with severe ocular ischemia with neovascularization which is very rare. As the patient showed signs of regression of neovascularization with systemic therapy, photocoagulation of the peripheral vascular retina was deferred. However, she needs close monitoring with prompt photocoagulation whenever the need arises.
| Conclusion|| |
In young women presenting with severe ocular ischemia with neovascularization, Takayasu arteritis should be considered and prompt evaluation has to be done. We need to look beyond the eye for possible systemic disease in cases of ocular ischemia in young. Furthermore, these patients should be closely followed up regularly for possible ocular and systemic complications.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
The authors express sincere thanks to the administrators, doctors, nurses, and other hospital staff of Yenepoya Medical College, Mangalore, for all the support rendered during the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]