Remarkable cases of temporal arteritis]

Blood-circulatory disorders and their end results at the fundus of the eye must always draw our attention to a possible Arteriitis temporalis Horton, even if there are no general symptoms, when the clinical picture disguises the vascular disease, or even when an important symptom of the disease, such as the accelerated basal sedimentation rate, is missing.     

An unusual presentation of temporal arteritis

Serious ocular and systemic complications may result from inflammatory processes of the orbit. Temporal arteritis is one such process that can affect the eye. The patient described herein is unusual because she presented initially with signs and symptoms similar to orbital cellulitis. As her disease evolved, she displayed marked, hemorrhagic chemosis with some limitation of abduction and resistance to retropulsion on the involved side. Laboratory and radiologic findings eliminated orbital cellulitis, limited Wegener's granulomatosis, and other systemic inflammatory disorders and led to the diagnosis of temporal arteritis. To our knowledge, this complex of presenting signs has not been previously reported.     

Color duplex ultrasound of the temporal artery: replacement for biopsy in temporal arteritis

The diagnosis of temporal arteritis (TA) is generally confirmed by biopsy. To investigate the diagnostic accuracy of color duplex sonography (CDS), both temporal arteries of 20 patients with suspected TA were prospectively insonated prior to biopsy. Detection of >or=1 hypoechogenic perivascular halo was used as CDS criterion, a temporal artery biopsy and the criteria of the American College of Rheumatology (ACR) as references. The frequency of halo disappearance after 3 months of steroid therapy was also studied. CDS showed TA in 6, biopsy in 12 and ACR criteria in 15 patients. CDS sensitivity was 50 and 40%, and specificity 100%, using the biopsy and the ACR criteria, respectively. After 3 months of steroid treatment, 1 patient still showed halos. In conclusion, detection of halos confirms, whereas the absence of halos does not exclude the diagnosis of TA suggesting that ultrasound may replace biopsy in single patients with typical clinical signs and symptoms and a halo.     

15例多发性大动脉炎眼底观察

目的 分析多发性大动脉炎眼底改变的视网膜微血管特征.方法 系列病例研究.收集多发性大动脉炎患者15例,均为女性,平均年龄(26.0±9.0)岁,所有患者均行眼科常规检查,包括视力、屈光、眼压、裂隙灯显微镜、眼底照相.12例行FFA,重点观察FFA表现,分析其眼底病变的特点.结果 15例患者中发病29眼(占97％),正常1跟(占3％),其中表现为缺血性眼底改变24眼(占80％),表现为高血压性眼底改变5眼(占17％).微动脉瘤是缺血型眼底病变的早期表现,且具有一些特征性的分布:广泛分布于周边部或中周部,大小基本一致,分布均匀,有向周边部分布更加密集的趋势.无灌注区广泛,从周边向视盘进行性发展.无灌注区边缘出现广泛的动静脉吻合,呈特征性的花冠状.晚期容易出现视盘新生血管,但没有视网膜新生血管.结论 多发性大动脉炎性眼底病变主要表现为缺血性眼底病变和高血压性眼底病变,以前者多见,这种慢性视网膜缺血具有一些特征性的眼底改变.2种病变也可同时表现于一眼眼底.     

Quantitative analysis of temporal artery contraction after biopsy for evaluation of giant cell arteritis

BACKGROUND: Although the degree of contraction of temporal artery biopsy specimens after formalin fixation has been previously reported to range from 6% to 13%, the degree of contraction before fixation has not been previously studied. The aim of this study was to quantify the postexcision (prefixation) contraction of temporal artery biopsy specimens and to determine the relationship between contraction and the result of the biopsy. METHODS: All patients undergoing temporal artery biopsies from February 2003 through May 2004 were retrospectively reviewed. Contraction was determined by subtracting the in vivo and ex vivo lengths, then dividing the difference by the in vivo length to obtain a percentage of contraction. Statistical analysis was performed with the unpaired t test and Fisher exact test. RESULTS: We reviewed 37 negative and 7 positive biopsies for giant cell arteritis (GCA). For specimens positive for GCA, the mean contraction was 12%, whereas for negative specimens, mean contraction was 22%. There was a significant difference in the contraction between the specimens positive and negative for GCA (p = 0.009). The Fisher exact test revealed that GCA was positively associated with arterial contraction of less than 15% (p = 0.002). INTERPRETATION: The temporal artery can contract substantially after excision and before tissue fixation. GCA-positive specimens exhibit statistically less contractility than negative specimens.     

Suspected giant cell arteritis: a study of referrals for temporal artery biopsy

Background: The purpose of this study is to describe the nature of cases undergoing temporal artery biopsy (TAB) for suspected giant cell arteritis (GCA). Methods: A retrospective review of case notes was undertaken for all patients on whom ophthalmologists had performed TAB in 2 teaching hospitals between 1995 and 2001. Presenting symptoms, referring specialty, TAB result, treatment, and discharge diagnosis were recorded.Results: Ophthalmologists performed TAB on 110 patients for suspected GCA. A variety of specialties referred patients to ophthalmology for TAB; presenting symptoms varied with referral source. Of the 110 TABs, 21 (19%) were reported as positive for GCA, 84 (76%) were negative, and 5 (4.5%) were reported as inadequate. The symptoms most commonly associated with a positive TAB were visual disturbance (15/21) and headache (15/21). The odds ratios for having a positive TAB result rather than a negative result were 1.0 for the presence of headache, 4.1 for visual disturbance, and 6.7 for jaw claudication. Interpretation: Physicians were faced with a different population of GCA suspects than ophthalmologists. While physicians should be alert to the significance of visual symptoms or jaw claudication, ophthalmologists should be ready to facilitate prompt TABs when appropriate. TAB should be performed promptly and an adequate length of artery taken for biopsy. An argument can be made that TAB is not needed in cases of suspected GCA. However, a positive result provides firm justification for the use of steroids. We feel that TAB has a useful role and we make reference to methods to maximize its usefulness.     

Necrosis of choroidal melanoma: in ciliary artery involvement with temporal arteritis.

A choroidal melanoma was clinically suspected in one eye of an 84-year-old farmer. At the time of the first examination the patient refused the studies necessary for a certain diagnosis as well as any treatment. Later, when the eye suddenly became blind and painful, it was enucleated. Pathological study revealed necrosis of all ocular contents, but the presence of a choroidal melanoma could still be verified histologically. The ciliary artery supplying the region of the melanoma was involved with giant cell arteritis. General examination of the patient gave support to a diagnosis of temporal arteritis, and steroid treatment resulted in general improvement.     

大动脉炎相关眼部症状临床特点初探

目的:探讨与大动脉炎相关的眼部症状的临床特点和发生机制。方法:回顾性分析69例大动脉炎患者的临床资料和相关眼部表现,对影响眼部症状的多因素进行logistic回归分析。结果:有15例(22%)患者出现眼部症状,其中视物模糊11例(73%),一过性黑朦6例(40%),视野缺损4例(27%),虹膜新生血管2例(11%)。大动脉炎眼部症状的出现与年龄、性别、病变分型、C反应蛋白、血沉等因素均无相关性。结论:大动脉炎可以引起多种眼部症状;局部低灌注引起的缺血缺氧是引发大动脉炎眼部症状的原因之一;对伴有眼部症状的大动脉炎患者在全身治疗的同时应给与针对眼部症状的治疗。     

Progressive visual loss in a patient with presumed temporal arteritis despite treatment: how to make the diagnosis

Giant cell (temporal) arteritis is a severe potentially fatal systemic vasculitis characterized by focal involvement of the cranial arteries resulting in ischaemic arterial occlusion. The case is presented of a 75-year-old woman with presumed giant cell arteritis and normal bilateral temporal artery biopsies. Despite a seemingly adequate course of systemic steroid therapy, the patient developed sudden catastrophic vision loss. Cerebral angiography and ultrasonography were useful investigations to determine the most appropriate artery to biopsy to confirm the diagnosis of giant cell arteritis.     

The role of ultrasound biomicroscopy in predicting the result of temporal artery biopsy in temporal arteritis patients: a preliminary study

PURPOSE: Temporal artery biopsy is considered the gold standard for the diagnosis of temporal arteritis (TA). However, complications following this procedure may occur. The goal of this study is to evaluate if ultrasound biomicroscope (UBM) findings are useful in predicting the result (positive or negative) of temporal artery biopsy in patients with TA. METHODS: Twenty-six consecutive patients with clinical diagnosis of TA seen at the Department of Ophthalmology, Royal Victoria Hospital, Montreal, Canada, were involved in this study. All patients were submitted to UBM before temporal artery biopsy. Eight patients presented histopathologic findings consistent with the diagnosis of TA. Thus, UBM findings of these patients were compared with those from 18 patients with negative biopsy. On UBM we searched for the presence of a hypoechoic effect surrounding the walls of the temporal arteries, the so-called halo sign, as well as an intra-arterial middle reflexive filling, the so-called intra-arterial filling. RESULTS: The halo sign and/or the intra-arterial filling were found in 8 (100%) of 8 patients with biopsy-proven TA. However, 10 (55.5%) of 18 patients with a negative biopsy presented one or both of these two UBM findings. On the other hand, the absence of these two parameters on the UBM of a patient with TA strongly suggests that the temporal artery biopsy will be negative (negative predictive value=100%). CONCLUSIONS: This preliminary work suggests that UBM may play a role in predicting a negative result of the temporal artery biopsy in patients with TA. In the present series approximately 30% of the patients could be spared this surgical procedure and its possible complications.     

Cotton-wool spots as the first manifestation of giant cell arteritis: two cases

PURPOSE/METHOD: The present study shows two patients with giant cell arteritis. Both patients showed single isolated cotton-wool spots as the only clinical manifestation. RESULTS/CONCLUSION: Single cotton-wool spots can be an early ophthalmoscopic finding in giant cell arteritis and can precede an important visual loss.     

眼眶神经鞘瘤30例分析

目的总结分析１９８５～１９９４年在我院经病理证实的孤立性眼眶神经鞘瘤。方法回顾性研究３０例孤立性眼眶神经鞘瘤的临床特点、诊断要点及治疗方法。对不同手术方法的术后并发症及术后复发情况进行了对比。结果孤立性眼眶神经鞘瘤多见于２０～４０岁青壮年，男女患病率差异无显著性。多表现为眼球突出，可伴有视力下降、眼部疼痛、眼球活动受限等。均行手术摘除肿瘤。术后视力下降８例（２６．７％），不变１３例（４３．３％），提高９例（３０．０％）；早期上睑下垂８例（２６．７％），眼球活动受限１１例（３６．７％）。术后随访１．５～１０．０年，５例复发，其中１例为低度恶性，４例为良性。大部分上睑下垂及眼球运动受限者，术后３～６个月恢复正常。结论应根据肿瘤的发生部位，选择最佳手术进路。