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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 3  |  Page : 433-434

Photic and postprandial amaurosis in Takayasu arteritis


Department of Ophthalmology, Tirunelveli Medical College Hospital, Tirunelveli, Tamil Nadu, India

Date of Submission06-Oct-2020
Date of Acceptance23-Feb-2021
Date of Web Publication02-Jul-2021

Correspondence Address:
Dr. Thendral Velmurugan
Department of Ophthalmology, Tirunelveli Medical College Hospital, Tirunelveli, Tamil Nadu, India
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_3175_20

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  Abstract 


Keywords: Central Retinal Artery Occlusion, photic amaurosis, postprandial amaurosis, takayasu arteritis


How to cite this article:
Anandhi J, Velmurugan T, Chellapandi G. Photic and postprandial amaurosis in Takayasu arteritis. Indian J Ophthalmol Case Rep 2021;1:433-4

How to cite this URL:
Anandhi J, Velmurugan T, Chellapandi G. Photic and postprandial amaurosis in Takayasu arteritis. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Jul 26];1:433-4. Available from: https://www.ijoreports.in/text.asp?2021/1/3/433/320111



A 31-year-old female presented with transient loss of vision lasting 10 min in both the eyes. The defective vision was transient lasting about 5–10 min at least once a day for about a month. It was aggravated by walking, exposure to bright light, and postprandially. On general examination, pulses and BP were not palpable in both the upper limbs and normal in both lower limbs. On ocular examination, visual acuity was RE-5/60 and LE-3/60. Pupils were 5 mm in size sluggishly reacting to light. Fundus examination showed a normal disc with cattle trucking of vessels in all the quadrants and no cherry red spot. A provisional diagnosis of impending CRAO in both eyes secondary to Takayasu arteritis was made. Oral prednisolone and aspirin were started. FFA showed increased arm to retina circulation time, delayed A–V transit time, and microaneurysms in the mid-periphery [Figure 1]. She complained of loss of vision on exposure to the fundus camera, which lasted for 60 s. Macaroni sign (homogenous and moderately echogenic circumferential thickening) was seen in the common carotid arteries on Doppler [Figure 2]. CT angiography showed collaterals in the circle of Willis [Figure 3]. MRI brain was normal. Further investigation revealed type-IIb Takayasu arteritis (TA).[1] The Best corrected visual acuity (BCVA) improved to 6/18 in both the eyes on day 7 and 6/9 by day 30.
Figure 1: (a) Fundus photograph showing cattle trucking of vessels, (b) FFA showing prolonged arm–retinal circulation time, and (c) late phase showing microaneurysm in all quadrants

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Figure 2: Carotid Doppler of common carotid artery showing macaroni sign suggestive of Takayasu arteritis

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Figure 3: CT angiography showing concentric thickening of both common carotid arteries, complete occlusion of left subclavian artery, thinning of the left vertebral artery

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  Discussion Top


Photic amaurosis occurs when there is an increased metabolic demand in the photoreceptors which exceeds the ability to oxygenate due to circulatory compromise. Postprandial amaurosis occurs because of the diversion of blood flow to GI tract.[2] The dilated sluggishly reacting pupil has been described as “tonic pupil” [Figure 4] resulting from chronic ischemia of sphincter.[3] Photic and postprandial amaurosis are unique symptoms which have been less frequently reported in the literature. The timely diagnosis and initiation of corticosteroids prevented bilateral CRAO in our patient.
Figure 4: Tonic pupil

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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.
Nastri MV, Baptista LP, Baroni RH, Blasbalg R, de Avila LF, Leite CC, et al. Gadolinium-enhanced three-dimensional MR angiography of Takayasu arteritis. Radiographics 2004;24:773-86.  Back to cited text no. 1
    
2.
Gatt M, MacFie J, Anderson ADG, Howell G, Reddy BS, Suppiah A, et al. Changes in superior mesenteric artery blood flow after oral, enteral, and parenteral feeding in humans. Crit Care Med 2009;37:171-6.  Back to cited text no. 2
    
3.
Matalia J, Kasturi N, Anaspure HD, Shetty BK. Tonic pupil, anterior ischemic optic neuropathy in a teenager with Takayasu arteritis. Can J Ophthalmol 2013;48:e159-63.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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