Vannozzi Lorenzo, Nicolosi Cristina, Vicini Giulio, Bacherini Daniela, Giattini Dario, Urban Maria Letizia, Palermo Adalgisa, Malandrino Danilo, Bello Federica, Virgili Gianni, Giansanti Fabrizio
Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy.
Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
Front Med (Lausanne). 2024 Aug 12;11:1408821. doi: 10.3389/fmed.2024.1408821. eCollection 2024.
We evaluated the clinical features and retinal and disk perfusion characteristics by using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in a subset of giant cell arteritis (GCA) patients who manifested anterior ischemic optic neuropathy (AION), in a subset of GCA patients without ocular involvement, and in a control group composed of healthy controls.
We performed an observational study on the eyes of GCA patients affected by arteritic AION both in acute and chronic phases, unaffected eyes of AION, eyes of GCA patients without ocular involvement, and in a control group of healthy eyes of healthy individuals. All patients underwent a complete ophthalmic examination and an OCT and OCTA of the macula and the disk.
The study evaluated 10 eyes of GCA patients with AION (AION group), 8 unaffected eyes of GCA patients with AION in another eye (unaffected eyes of AION group), 16 eyes of GCA patients without ocular involvement (non-ocular group), and 22 eyes of healthy patients (healthy group). The ganglion cell complex (GCC) superior and inferior thicknesses were significantly lower in the AION group compared to the unaffected eyes of the AION group ( = 0.045 and = 0.034, respectively). All OCTA vascular density parameters of the optic disk analyzed in this study (optic nerve head (ONH) whole, superior, inferior, radial peripapillary capillary plexus (RPCP) whole, superior, inferior, lamina cribrosa (LC) whole, superior, inferior) resulted significantly lower in the AION group compared to the unaffected eyes group ( < 0.05 for all the comparisons). The ONH whole and inferior were statistically higher in the healthy group in comparison to the group of GCA patients without ocular involvement ( = 0.008 and = 0.006, respectively). The ONH inferior was also statistically higher in the unaffected eyes of the AION group in comparison to the non-ocular group ( = 0.045). Regarding the OCTA macular vessel density parameters, the superficial capillary plexus (SCP), whole and inner, were statistically lower in the AION group compared with the unaffected eyes of the AION group.
We found a profound vascular impairment in eyes affected by AION and areas of hypoperfusion in the eyes of patients with GCA without ocular involvement, good BCVA, and no clinically significant features. We hypothesized that these areas of lower vessel density might represent areas of subclinical hypoperfusion that cannot be detected ophthalmoscopically.
我们使用光学相干断层扫描（OCT）和光学相干断层扫描血管造影（OCTA）评估了巨细胞动脉炎（GCA）患者中表现为前部缺血性视神经病变（AION）的亚组、无眼部受累的GCA患者亚组以及由健康对照组成的对照组的临床特征、视网膜和视盘灌注特征。
我们对处于急性和慢性期的动脉炎性AION的GCA患者的患眼、AION患者的未受累眼、无眼部受累的GCA患者的眼睛以及健康个体的健康眼睛对照组进行了观察性研究。所有患者均接受了全面的眼科检查以及黄斑和视盘的OCT和OCTA检查。
该研究评估了10例GCA合并AION患者的患眼（AION组）、8例GCA合并AION患者的另一只未受累眼（AION组未受累眼）、16例无眼部受累的GCA患者的眼睛（非眼部组）以及22例健康患者的眼睛（健康组）。与AION组未受累眼相比，AION组的神经节细胞复合体（GCC）上下厚度显著更低（分别为=0.045和=0.034）。本研究中分析的视盘所有OCTA血管密度参数（视神经乳头（ONH）整体、上部、下部、放射状视乳头周围毛细血管丛（RPCP）整体、上部、下部、筛板（LC）整体、上部、下部）在AION组中均显著低于未受累眼组（所有比较均<0.05）。与无眼部受累的GCA患者组相比，健康组的ONH整体和下部在统计学上更高（分别为=0.008和=0.006）。与非眼部组相比，AION组未受累眼中的ONH下部在统计学上也更高（=0.045）。关于OCTA黄斑血管密度参数，与AION组未受累眼相比，AION组的浅表毛细血管丛（SCP）整体和内层在统计学上更低。
我们发现在受AION影响的眼睛以及无眼部受累、最佳矫正视力良好且无临床显著特征的GCA患者眼睛中存在严重的血管损伤和灌注不足区域。我们推测这些血管密度较低的区域可能代表了无法通过检眼镜检测到的亚临床灌注不足区域。
