回顾性、多中心比较巨细胞动脉炎与其他原因导致复视患者的临床表现。
Retrospective, Multicenter Comparison of the Clinical Presentation of Patients Presenting With Diplopia From Giant Cell Arteritis vs Other Causes.
机构信息
Department of Ophthalmology (AGR, MP, GTL, KSS, MAT), Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Ophthalmology (IJ), University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology (GR), Cornell Medical Center, New York, New York; Department of Ophthalmology and Neurology (JJ-WC), Mayo Clinic, Rochester, New York; Department of Ophthalmology (RCS, MM), Wills Eye Hospital, Philadelphia, Pennsylvania; Department of Ophthalmology & Visual Sciences (CAS), University of British Columbia, Vancouver, British Columbia, Canada; Department of Ophthalmology (RF), Baylor College of Medicine, Houston, Texas; Department of Neurology (MWK), SUNY Upstate Medical University, Syracuse, New York; Department of Ophthalmology (CEF), University of Washington, Seattle, Washington; Department of Ophthalmology (ZRW), Flaum Eye Institute, University of Rochester Medical Center, Rochester, New York; Houston Methodist Ophthalmology Associates (AGL, SY, EP, MR), Houston, Texas; Department of Ophthalmology and Visual Neurosciences (CMM), University of Minnesota, Minneapolis, Minnesota; Department of Neurology and Ophthalmology (BO), Georgetown University, Washington DC; New England Eye Center (TRH), Tufts University, Boston, Massachusetts; Department of Ophthalmology and Neurology (GPVS, IG-B), Washington University, St. Louis, Missouri; and Department of Ophthalmology, University Hospital Virgen de la Victoria, Campus Teatinos, Málaga, Spain.
出版信息
J Neuroophthalmol. 2019 Mar;39(1):8-13. doi: 10.1097/WNO.0000000000000656.
BACKGROUND
Although giant cell arteritis (GCA) is a well-known cause of transient and permanent vision loss, diplopia as a presenting symptom of this condition is uncommon. We compared symptoms and signs of patients presenting with diplopia from GCA to those from other causes.
METHODS
This was a multicenter, retrospective study comparing the clinical characteristics of patients presenting with diplopia from GCA with age-matched controls. Demographic information, review of symptoms, ophthalmic examination, and laboratory data of biopsy-proven patients with GCA were compared with those of age-matched controls presenting with diplopia.
RESULTS
A total of 27 patients presented with diplopia from GCA, 19 with constant diplopia, and 8 with transient diplopia. All patients with constant diplopia from GCA were matched with 67 control subjects who had diplopia from other etiologies. Patients with GCA were more likely to describe other accompanying visual symptoms (58% vs 25%, P = 0.008), a greater number of systemic GCA symptoms (3.5, GCA vs 0.6, controls, P < 0.001) such as headache (94% [17/18] vs 39% [23/67]; P < 0.001), jaw claudication (80% [12/15] vs 0% [0/36]; P < 0.001), and scalp tenderness (44% [7/16] vs 7% [3/43]; P < 0.001). Ocular ischemic lesions (26% vs 1%, P < 0.001) were also common in patients with diplopia from GCA. Inflammatory markers were elevated significantly in patients with GCA vs controls (erythrocyte sedimentation rate: 91% [10/11] vs 12% [3/25], P < 0.001; C-reactive protein: 89% [8/9] vs 11% [2/19], P < 0.001).
CONCLUSIONS
GCA is a rare but serious cause of diplopia among older adults and must be differentiated from other more common benign etiologies. Our study suggests that most patients with diplopia from GCA have concerning systemic symptoms and/or elevated inflammatory markers that should trigger further work-up. Moreover, careful ophthalmoscopic examination should be performed to look for presence of ocular ischemic lesions in older patients presenting with acute diplopia.
背景
尽管巨细胞动脉炎（GCA）是导致暂时性和永久性视力丧失的已知原因，但作为这种疾病的首发症状，复视并不常见。我们比较了以复视为首发症状的 GCA 患者和其他病因患者的症状和体征。
方法
这是一项多中心、回顾性研究，比较了以复视为首发症状的 GCA 患者与年龄匹配的对照组的临床特征。比较了活检证实的 GCA 患者和年龄匹配的复视对照组患者的人口统计学信息、症状回顾、眼科检查和实验室数据。
结果
共有 27 例 GCA 患者出现复视，19 例为持续性复视，8 例为一过性复视。所有持续性复视的 GCA 患者均与 67 例其他病因复视的对照组患者相匹配。GCA 患者更有可能描述其他伴随的视觉症状（58%比 25%，P=0.008），出现更多的全身性 GCA 症状（3.5，GCA 比 0.6，对照组，P<0.001），如头痛（94%[17/18]比 39%[23/67]；P<0.001）、下颌运动障碍（80%[12/15]比 0%[0/36]；P<0.001）和头皮触痛（44%[7/16]比 7%[3/43]；P<0.001）。眼部缺血性病变（26%比 1%，P<0.001）在 GCA 复视患者中也很常见。与对照组相比，GCA 患者的炎症标志物明显升高（红细胞沉降率：91%[10/11]比 12%[3/25]，P<0.001；C 反应蛋白：89%[8/9]比 11%[2/19]，P<0.001）。
结论
GCA 是老年人复视的罕见但严重原因，必须与其他更常见的良性病因相鉴别。我们的研究表明，大多数以复视为首发症状的 GCA 患者都有令人担忧的全身症状和/或升高的炎症标志物，这应该促使进一步检查。此外，对于出现急性复视的老年患者，应进行仔细的眼底检查，以寻找眼部缺血性病变的存在。
Zotero 插件