Wang Wei-wei, Ye Jun-jie, Chen You-xin, Dai Rong-ping
Department of Ophthalmology, Chinese Academy of Medical Sciences, Beijing, China.
Zhonghua Yan Ke Za Zhi. 2012 Feb;48(2):124-30.
To evaluate the fundus manifestation and treatment of Takayasu's arteritis.
Retrospective case series was taken to study the clinical data of 15 patients (30 eyes) diagnosed with Takayasu's arteritis at Peking Union Medical College Hospital from 1992 to 2010. Examinations included visual acuity, slit-lamp, fundus, fundus fluorescein angiography (FFA), large vascular ultrasound, digital subtraction angiography (DSA), erythrocyte sedimentation rate (ESR) and reactive protein C (CRP). All patients were given systemic corticosteroids, immunosuppressive agents and anticoagulants. Three patients (4 eyes) received retinal photocoagulation, and 1 patient (1 eye) received vitrectomy combined with silicone oil tamponade.
Fifteen cases aged 13 - 49 years [mean (33.6 ± 11.1) years] were enrolled, including 2 male and 13 female patients. Two patients recognized by initial presentation of impaired vision prior to the diagnosis of Takayasu's arteritis. Visual acuity: light perception -0.05, 6 eyes; 0.1 - 0.5, 4 eyes; 0.6 - 1.0, 5 eyes; and above 1.0, 15 eyes. The fundus examination revealed chronic ischemic retinopathy in 16 eyes characterized by microaneurysms, cotton-wool spots and peripapillary arteriovenous anastomosis, and complicated by vitreous hemorrhage, retinal detachment and proliferative retinopathy at the late stage. There was hypertensive retinopathy in 14 eyes with features of narrow retinal artery, arteriovenous crossing signs and retinal hemorrhage. FFA showed prolonged arm-to-retina circulation time and retinal circulation time, microaneurysms and neovasculature. Six cases were classified as brachiocephalic arteritis, and 9 patients belonged to extensive arteritis. ESR increased in 9 patients and CRP elevated in 5 patients. Capillary non-perfusion areas in 4 eyes subsided after retinal photocoagulation, and retina reattached in 1 eye after vitrectomy with visual acuity improved from light perception to count finger.
Fundus manifestation of Takayasu's arteritis is usually characterized by chronic ischemic retinopathy and hypertensive retinopathy, and complications such as vitreous hemorrhage, retinal detachment and proliferative retinopathy occur at advanced stage. The first symptom in some patients can be impaired vision. The prognosis could be improved if ophthalmologists know fundus characteristics of Takayasu's arteritis and give timely and correct diagnosis and treatment.
评估大动脉炎的眼底表现及治疗方法。
采用回顾性病例系列研究方法，对1992年至2010年在北京协和医院确诊为大动脉炎的15例患者（30只眼）的临床资料进行分析。检查项目包括视力、裂隙灯、眼底、眼底荧光血管造影（FFA）、大血管超声、数字减影血管造影（DSA）、红细胞沉降率（ESR）和C反应蛋白（CRP）。所有患者均接受全身糖皮质激素、免疫抑制剂和抗凝剂治疗。3例患者（4只眼）接受了视网膜光凝治疗，1例患者（1只眼）接受了玻璃体切割联合硅油填充术。
纳入15例年龄在13 - 49岁[平均（33.6±11.1）岁]的患者，其中男性患者2例，女性患者13例。2例患者在大动脉炎诊断之前以视力下降为首发表现。视力情况：光感 - 0.05，6只眼；0.1 - 0.5，4只眼；0.6 - 1.0，五只眼；大于1.0，15只眼。眼底检查发现16只眼表现为慢性缺血性视网膜病变，特征为微动脉瘤、棉絮斑和视乳头周围动静脉吻合，并在晚期并发玻璃体积血、视网膜脱离和增殖性视网膜病变。14只眼表现为高血压性视网膜病变，特征为视网膜动脉变窄、动静脉交叉征和视网膜出血。FFA显示臂 - 视网膜循环时间和视网膜循环时间延长，微动脉瘤和新生血管形成。6例患者被归类为头臂型动脉炎，9例患者属于广泛型动脉炎。9例患者ESR升高，5例患者CRP升高。4只眼的毛细血管无灌注区在视网膜光凝治疗后消退，1只眼在玻璃体切割术后视网膜复位，视力从光感提高到能数指。
大动脉炎的眼底表现通常以慢性缺血性视网膜病变和高血压性视网膜病变为特征，晚期可出现玻璃体积血、视网膜脱离和增殖性视网膜病变等并发症。部分患者的首发症状可为视力下降。眼科医生了解大动脉炎的眼底特征并及时给予正确的诊断和治疗，可改善预后。
