Héron Emmanuel, Sedira Neila, Dahia Ouassila, Jamart Céline
Department of Internal Medicine, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, 28 Rue de Charenton, 75012 Paris, France.
J Clin Med. 2022 Apr 2;11(7):1997. doi: 10.3390/jcm11071997.
The risk of blindness, due to acute ischemic ocular events, is the most feared complication of giant cell arteritis (GCA) since the middle of the 20th century. A decrease of its rate has occurred after the advent of corticoid therapy for this vasculitis, but it seems to have stabilized since then. Early diagnosis and treatment of GCA is key to reducing its ocular morbidity. However, it is not uncommon for ophthalmological manifestations to inaugurate the disease, and the biological inflammatory reaction may be mild, making its diagnosis more challenging. In recent years, vascular imaging has opened up new possibilities for the rapid diagnosis of GCA, and ultrasound has taken a central place in fast-track diagnostic processes. Corticosteroid therapy remains the cornerstone of treatment and must begin immediately in patients with visual symptoms and suspicion of GCA. In that situation, the administration route of corticotherapy, intravenous or oral, is less important than its speed of delivery, any hour of delay worsening the prognosis.
自20世纪中叶以来，急性缺血性眼部事件导致失明的风险一直是巨细胞动脉炎（GCA）最令人担忧的并发症。自针对这种血管炎的皮质类固醇疗法出现后，其发生率有所下降，但此后似乎已趋于稳定。GCA的早期诊断和治疗是降低其眼部发病率的关键。然而，以眼科表现作为该病首发症状的情况并不少见，而且生物炎症反应可能较为轻微，这使得其诊断更具挑战性。近年来，血管成像为GCA的快速诊断开辟了新的可能性，超声在快速诊断过程中占据了核心地位。皮质类固醇疗法仍然是治疗的基石，对于有视觉症状且怀疑患有GCA的患者必须立即开始治疗。在这种情况下，皮质类固醇治疗的给药途径，静脉注射或口服，不如给药速度重要，任何一小时的延迟都会使预后恶化。
