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Optical coherence tomographic angiography identifies peripapillary microvascular dilation and focal non-perfusion in giant cell arteritis
  1. Eric D Gaier,
  2. Aubrey L Gilbert,
  3. Dean M Cestari,
  4. John B Miller
  1. Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr John B Miller, Retina Service, Mass. Eye and Ear Infirmary, Harvard Medical School, Boston, MA, 02114; john_miller{at}meei.harvard.edu

Abstract

Aims We set out to determine the optical coherence tomographic angiography (OCT-A) characteristics of arteritic anterior ischaemic optic neuropathy (AAION) in the context of giant cell arteritis (GCA).

Methods This is an observational case series of four patients with AAION secondary to GCA, three with unilateral AAION and one with bilateral AAION. We reviewed the charts, fundus photography, visual fields, fluorescein angiography (FA) and OCT-A images for all patients to identify a unifying theme in a range of AAION clinical severity. Imaging of two healthy control eyes from two patients of similar age to the patients in our series were used for comparison.

Results Superficial peripapillary capillary dilation was seen in eyes with acute AAION. It was also noted in the fellow eyes of two patients. Retinal capillary perfusion defects corresponded to visual field loss. Dense optic disc oedema and cotton-wool spots imparted blockage effects. OCT-A laminar analysis did not highlight the choroidal/choriocapillaris perfusion defects seen on FA in two patients. Follow-up OCT-A was obtained in two patients and revealed progression to superficial peripapillary capillary attenuation that corresponded with visual field loss.

Conclusions There are acute and chronic vascular changes in AAION that are detectable by OCT-A that correspond with visual function. Though the microvascular changes seen in GCA and AAION are not specific, the nearly ubiquitous findings among preclinical and clinically affected eyes in this series of patients with GCA support OCT-A as a potentially useful adjunctive diagnostic test in the work-up of ambiguous cases of suspected ischaemic optic neuropathy.

  • optic nerve
  • imaging

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Footnotes

  • Contributors EDG and ALG contributed equally to this work. EDG and JBM collected the images. EDG, ALG and JBM interpreted the images. EDG, ALG, DMC and JBM all took part in writing the manuscript.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Institutional review board at MEEI (protocol no. 16-038H).

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement Raw images are available upon request. Please contact Eric Gaier at eric_gaier@meei.harvard.edu.

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