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Occult giant cell arteritis: Ocular manifestations - 09/09/11

Doi : 10.1016/S0002-9394(99)80193-7 
Sohan Singh Hayreh, MD, PhD, DSc a, , 1 , Patricia A. Podhajsky, BSN a, Bridget Zimmerman, PhD b
a From the Departments of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, Iowa, USA 
b From the Preventive Medicine and Environmental Health (Division of Biostatistics), College of Medicine, University of Iowa, Iowa City, Iowa, USA 

**Reprint requests to S. S. Hayreh, MD, PhD, Department of Ophthalmology and Visual Sciences, University Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242-1091; fax: (319) 353-7996.

Abstract

Purpose

To report the incidence, visual symptoms, and ocular signs of occult giant cell arteritis in patients who initially presented with visual symptoms and ocular signs of giant cell arteritis. Occult giant cell arteritis was defined as ocular involvement by giant cell arteritis without any systemic symptoms and signs of giant cell arteritis.

Methods

In a prospective study from 1973 to 1995, we investigated 85 patients who had ocular involvement caused by giant cell arteritis and whose diagnosis of giant cell arteritis was confirmed on temporal artery biopsy. At the initial visit, patients were questioned specifically on systemic and ocular symptoms and signs of giant cell arteritis at or before the onset of visual disturbance. Erythrocyte sedimentation rate (Westergren) and C-reactive protein level were evaluated before the start of systemic corticosteroid therapy.

Results

Eighteen (21.2%) of 85 patients had occult giant cell arteritis. There was no significant difference in age and sex distribution between patients with and without systemic symptoms of giant cell arteritis. Although both groups of patients had abnormal erythrocyte sedimentation rate and C-reactive protein level, there was a significant difference in erythrocyte sedimentation rate (P <.0001) and C-reactive protein level (P =

Conclusions

Because occult giant cell arteritis is a potential cause of blindness, its early diagnosis is the key to preventing blindness; it is important to recognize that 21.2% of patients with giant cell arteritis and visual loss do not have any systemic symptoms of giant cell arteritis. Thus, in persons older than 55 years, amaurosis fugax or visual loss, development of an acute ocular ischemic lesion (particularly arteritic anterior ischemic optic neuropathy), and abnormal C-reactive protein level, with or without elevated erythrocyte sedimentation rate and systemic symptoms, should raise a high index of suspicion for giant cell arteritis.

Le texte complet de cet article est disponible en PDF.

* Supported by grants EY-1151 and RR-59 from the National Institutes of Health, Bethesda, Maryland, and in part by unrestricted grants from Research to Prevent Blindness, Inc, New York, New York.


© 1998  Publié par Elsevier Masson SAS.
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Vol 125 - N° 4

P. 521-526 - avril 1998 Retour au numéro
Article précédent Article précédent
  • Ocular manifestations of giant cell arteritis
  • Sohan Singh Hayreh, Patricia A. Podhajsky, Bridget Zimmerman
| Article suivant Article suivant
  • The ophthalmology of intracranial vascular abnormalities
  • Valérie Biousse, Maria E. Mendicino, Deborah J. Simon, Nancy J. Newman

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