Coffin-Pichonnet S, Bienvenu B, Mouriaux F
Service d'ophtalmologie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen, France.
J Fr Ophtalmol. 2013 Feb;36(2):178-83. doi: 10.1016/j.jfo.2012.11.002. Epub 2013 Jan 16.
Giant cell arteritis, temporal arteritis is a systemic vasculitis, which involves large and medium-sized arteries, especially the extracranial branches of the carotid arteries, in patients above the age of 50. Ischemic complications may involve the eye, orbit, or visual pathway, with blindness being the most feared complication. Visual ischemic complications are observed at least in 25% of patients with giant cell arteritis. Irreversible visual loss is mainly due to acute anterior ischemic optic neuropathy. Thus, in any patient above the age of 50 with any manifestation of ocular ischemia, transient or permanent, giant cell arteritis must be considered and ruled out by an emergent targeted investigation and inflammatory work-up. Steroids remain the treatment of choice for giant cell arteritis and must be instituted immediately upon suspicion of the diagnosis, even in the physician's office. The goal is to protect the eye and visual pathways from irreversible blindness or to prevent contralateral disease. Thus, steroid treatment does not constitute a cure for already-incurred visual loss, which will still carry an unfavourable prognosis.
巨细胞动脉炎,即颞动脉炎,是一种系统性血管炎,累及50岁以上患者的大中型动脉,尤其是颈动脉的颅外分支。缺血性并发症可能累及眼睛、眼眶或视觉通路,失明是最可怕的并发症。至少25%的巨细胞动脉炎患者会出现视觉缺血性并发症。不可逆性视力丧失主要是由于急性前部缺血性视神经病变。因此,对于任何50岁以上出现眼部缺血表现(无论是短暂性还是永久性)的患者,都必须考虑巨细胞动脉炎,并通过紧急针对性检查和炎症检查予以排除。类固醇仍然是巨细胞动脉炎的首选治疗方法,即使是在医生办公室,一旦怀疑诊断成立,就必须立即使用。目标是保护眼睛和视觉通路以免发生不可逆性失明或预防对侧疾病。因此,类固醇治疗并不能治愈已经发生的视力丧失,其预后仍然不佳。