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Year : 2021  |  Volume : 1  |  Issue : 1  |  Page : 71

Bilateral central retinal artery occlusion in a patient with diagnosed Takayasu's arteritis


Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Date of Submission07-Apr-2020
Date of Acceptance12-Jul-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Shorya Vardhan Azad
Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_868_20

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  Abstract 


Keywords: Pulseless disease, retinal artery occlusion, takayasu's arteritis


How to cite this article:
Vukkadala T, Balaji A, Azad SV, Kumar V. Bilateral central retinal artery occlusion in a patient with diagnosed Takayasu's arteritis. Indian J Ophthalmol Case Rep 2021;1:71

How to cite this URL:
Vukkadala T, Balaji A, Azad SV, Kumar V. Bilateral central retinal artery occlusion in a patient with diagnosed Takayasu's arteritis. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Feb 26];1:71. Available from: https://www.ijoreports.in/text.asp?2021/1/1/71/305544



A 20-year-old male presented with the sudden onset diminution of vision in both eyes (BE) for 15 days. He was previously diagnosed with Takayasu's Arteritis (TA). Systemic examination revealed feeble bilateral brachial and radial arterial pulses. His pulse rate was 126 beats/minute and blood pressure was 90/65 mm Hg on the right side and 100/72 mm Hg on the left side. On examination, visual acuity was counting fingers at 1 meter in BE. Fundoscopy revealed mild retinal pallor at the posterior pole and cherry red spot at the fovea bilaterally [Figure 1]a and [Figure 1]b. A diagnosis of bilateral central retinal artery occlusion (CRAO) was made. Optical coherence tomography (OCT) demonstrated hyperreflectivity of the inner retinal layers [Figure 1]c and [Figure 1]d. Fluorescein angiography revealed delayed arterial filling in BE, thus confirming the diagnosis of bilateral CRAO. He was managed with systemic corticosteroids as the pathology was primarily of inflammatory origin. Prognosis was explained and rheumatologist follow up was advised to rule out systemic relapse.
Figure 1: Fundus photograph showing mild retinal pallor with a cherry red spot OD (a) and OS (b). Spectral domain OCT showing hyperreflectivity of inner retinal layers OD (c) and OS (d)

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  Discussion Top


CRAO has been reported to be bilateral in 1–2% of cases. TA is a chronic inflammatory disorder predominantly seen in young people. Also known as pulseless disease, it is characterized by pan-arteritis with intimal proliferation. The pathogenesis of CRAO is attributed to arteritis of vasa vasorum as well as obliteration of the carotid arteries resulting in hypoperfusion.[1] More common ocular complications include retinal ischemia, proliferative retinopathy, vitreous hemorrhage, and retinal detachment.[2] Rarely, branch retinal artery occlusion (BRAO) has been reported.[3] Young patients presenting with CRAO/BRAO mandate a high index of suspicion to rule out systemic involvement. Although ocular activity may not be associated with a concurrent systemic activity, rheumatologist referral is preferable. To the best of our knowledge, this is the first case reporting bilateral CRAO in a patient with TA.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Guclu H, Gurlu VP, Ozal SA, Guclu O. Central retinal artery occlusion in Takayasu's arteritis as the first presentation of the disease. Case Rep Ophthalmol Med 2016;2016:6492513.  Back to cited text no. 1
    
2.
Pallangyo P, Epafra E, Nicholaus P, Lyimo F, Kazahura P, Janabi M. Bilateral ocular ischemia-induced blindness as a presenting manifestation of Takayasu arteritis: A case report. J Med Case Rep 2017;11:153.  Back to cited text no. 2
    
3.
Kaushik S, Gupta A, Gupta V, Jain S, Lal V. Retinal arterial occlusion in Takayasu's arteritis. Indian J Ophthalmol 2005;53:194-6.  Back to cited text no. 3
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