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Impairment of central retinal artery hemodynamics in affected and fellow eyes in giant cell arteritis patients with unilateral vision loss.

Authors :
Boutigny A
Mohamedi N
Pardo SJ
Bonnin S
Ketfi C
Ghaouti H
Viana V
Frazier A
Roos C
Burlacu R
Comarmond C
Kubis N
Sène D
Bonnin P
Source :
Autoimmunity reviews [Autoimmun Rev] 2023 Mar; Vol. 22 (3), pp. 103272. Date of Electronic Publication: 2023 Jan 14.
Publication Year :
2023

Abstract

Objectives: Permanent visual impairment is a major complication of giant cell arteritis (GCA). We investigated the added value of color Doppler imaging (CDI) of the central retinal artery (CRA) in patients with suspected GCA for early risk evaluation before temporal artery biopsy (TAB) results become available.<br />Methods: We conducted a non-interventional observational study of 30 consecutive patients hospitalized for suspected GCA, including a comprehensive analysis of clinical, laboratory, imaging, CDI and pathology data. GCA was diagnosed or excluded (GCA+, GCA-, respectively) according to American College of Rheumatology (ACR) criteria and TAB findings. Three patients not meeting ACR criteria were excluded secondarily. The GCA- group contained ten patients, and the GCA+ group contained 17 patients, including eight with unilateral, transient or permanent clinical visual impairment (CVI).<br />Results: Mean blood flow velocity (mBFV) in the CRA was impaired in the affected eyes of GCA + CVI+ patients (1.9 ± 0.9 cm.s <superscript>-1</superscript> , p < 0.001) relative to controls (4.1 ± 1.0 cm.s <superscript>-1</superscript> ), GCA- patients (3.6 ± 0.7 cm.s <superscript>-1</superscript> ) and GCA + CVI- patients (3.8 ± 0.8 cm.s <superscript>-1</superscript> ). The mBFVs of the CRA was similar for affected and fellow eyes (right or left). CRA mBFV measurements effectively differentiated between patients with and without CVI (ROC-curve analysis, AUC = 0.925 [95%CI: 0.700 to 0.996], p < 0.0001, 88% sensitivity, 89% specificity, and cutoff of ≤2.7 cm.s <superscript>-1</superscript> for affected eyes; 75% sensitivity, 100% specificity and cutoff of ≤2.2 cm.s <superscript>-1</superscript> for fellow eyes).<br />Conclusion: CDI facilities the early detection of visual ischemia risk in GCA+ patients, justifying urgent high-dose corticosteroid administration to save at least the fellow eye before pathology results become available.<br />Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.<br /> (Copyright © 2023 Elsevier B.V. All rights reserved.)

Details

Language :
English
ISSN :
1873-0183
Volume :
22
Issue :
3
Database :
MEDLINE
Journal :
Autoimmunity reviews
Publication Type :
Academic Journal
Accession number :
36649878
Full Text :
https://doi.org/10.1016/j.autrev.2023.103272