Kapran Z, Atmaca L S, Albayrak Z, Uyar M, Eltutar K
Department of Ophthalmology, SSK Istanbul Hospital, Turkey.
Eur J Ophthalmol. 2001 Jan-Mar;11(1):93-6. doi: 10.1177/112067210101100120.
Although significant decrease in retinal perfusion is usually not observed before all of the cervical arteries became markedly narrowed in patients with Takayasu's disease (TD), we present bilateral glaucomatous optic neuropathy in a patient with TD without any cervical arterial stenosis.
Ophthalmoscopic examination disclosed glaucomatous optic neuropathy in both eyes with 7/10-cup/disc ratio in the right eye and 9/10 in the left eye. Left subclavian selective arteriographic examination demonstrated segmental high-grade stenosis, namely 90 percent stenosis in the mid portion of the left subclavian artery. Arteriography, digital subtraction angiography (DSA), magnetic resonance angiography (MRA) and color Doppler sonography revealed patent cervical, carotid interna, ophthalmic, retinal and posterior ciliary arteries.
Patient was followed up for 48 months with frequent intervals and there was no deterioration of visual acuity, visual field and optic neuropathy without any antiglaucomatous treatment.
Although it is a known fact that classical ophthalmic manifestations of the TD occur only when major cervical arteries are occluded, no occlusion was observed in this patient with bilateral optic atrophy. The optic nerve damage is caused by various factors, but these factors require much elucidation before the optic neuropathy can be understood.
虽然在高安氏病（TD）患者中，通常在所有颈总动脉明显狭窄之前不会观察到视网膜灌注显著下降，但我们报告了一例无任何颈动脉硬化的TD患者出现双侧青光眼性视神经病变。
眼底检查发现双眼青光眼性视神经病变，右眼杯盘比为7/10，左眼为9/10。左锁骨下动脉选择性血管造影检查显示节段性高度狭窄，即左锁骨下动脉中段90%狭窄。血管造影、数字减影血管造影（DSA）、磁共振血管造影（MRA）和彩色多普勒超声检查显示颈总动脉、颈内动脉、眼动脉、视网膜动脉和睫状后动脉通畅。
患者接受了48个月的频繁随访，在未进行任何抗青光眼治疗的情况下，视力、视野和视神经病变均未恶化。
虽然已知TD的典型眼部表现仅在主要颈总动脉闭塞时出现，但该例双侧视神经萎缩患者未观察到血管闭塞。视神经损伤由多种因素引起，但在理解视神经病变之前，这些因素需要更多的阐明。
