THICKENED RETINAL GANGLION CELL COMPLEX IN PATIENT WITH SEVERE TAKAYASU RETINOPATHY AT EARLY STAGE

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Abstract

Purpose:

Takayasu arteritis is caused by an autoimmune process that results in chronic granulomatous inflammation. We describe the optical coherence tomographic findings in a case of Stage 4 Takayasu retinopathy.

Methods:

Case report and evaluation by optical coherence tomography.

Patient:

A 31-year-old woman visited our clinic because of bilateral blurred vision that began 1 month earlier. Examination showed that her visual acuities were 20/33 in the right and 20/100 in the left. The anterior segments were normal but retinal arteriovenous anastomosis shunts were detected on the optic disk of the both eyes, and vitreous hemorrhage was found in the left eye.

Results:

Spectral domain optical coherence tomography showed a thickening of the retinal ganglion cell complex and inner plexiform layer around the optic disk with dilated retinal arteriovenous shunts near the nerve fiber layer. Irregular hyperreflectivity was also seen between the outer plexiform layer and the outer nuclear layer especially at the temporal raphe. Steroid pulse therapy was begun with 500 mg/day intravenous methylprednisolone for 3 days, followed by oral prednisolone and antiplatelet agents. After 2 months, the retinal arteriovenous shunts on the optic disk of the right eye had a fibrovascular membrane-like appearance, and fluorescein angiography showed a progression of the retinal anastomosis and capillary nonperfusion especially in the temporal area. The thickened retinal ganglion cell complex around the optic disk remained but the irregular hyperreflectivity between the outer plexiform layer and the outer nuclear layer at the temporal raphe became smoother in both eyes.

Conclusion:

Optical coherence tomography can be useful in detecting retinal ischemia and the degree of inflammation in Takayasu retinopathy especially at the early stage.

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