• temporal artery biopsies

We read with interest the paper by Galloway and colleagues which suggests that ophthalmologists are best suited to perform temporal artery biopsies.¹ We recently completed a retrospective study of all the temporal artery biopsies performed at four teaching hospitals (Hammersmith Hospital, Charing Cross Hospital, St Mary’s Hospital and The Western Eye Hospital) in north London between January 1998 and January 2002. Ninety one patients underwent 92 biopsies. Of these, 15 were positive for temporal arteritis implying a 16% positive biopsy rate which is compatible with Galloway et al’s results. Ophthalmologists performed 54 biopsies (59%) while general and vascular surgeons (GVS) performed 38 biopsies (31%). Both groups had similar positive biopsy rates—ophthalmologists 10/54 (19%) and GVS 5/28 (13%). In an analysis of the ability to perform biopsies, the ophthalmologists had two failed biopsies (one specimen—no artery identified and one specimen—crushed artery) while the GVS group had one failed biopsy (no artery identified). The average artery length was 13.0 mm (range 5–21 mm) for the ophthalmologists and 14.0 mm (range 7–22 mm) for the GVS group.

We disagree with Galloway and colleagues’ assertions that ophthalmologists are best suited to performing temporal artery biopsies as our study found that both groups of surgeons obtained similar lengths of artery and had similar positive biopsy rates. We note that in their study, while the vascular surgeons only performed two of the 41 biopsies, the average length of specimen obtained was 22.5 mm, thus suggesting that the vascular surgeons may well be the best group to perform these biopsies. In Charing Cross Hospital, the vascular surgeons routinely use a Doppler ultrasound probe to help detect and demarcate the superficial temporal artery before biopsy and this practice has been advocated by other studies to help improve the yield of the biopsy.^2,3 In our study, all the biopsies performed by ophthalmologists were done as extra cases in theatre and seven cases had to be performed outside normal working hours as emergencies because of lack of theatre time. The fact that ophthalmologists performed 59% of biopsies may be due to the fact that all four hospitals had large neurological and rheumatological units attached to them. We feel that both ophthalmologists and general and vascular surgeons are equally capable of performing temporal artery biopsies and that guidelines should be designed locally to decide who should perform the biopsies. More importantly, the follow up of these patients should be clearly stated and be ideally under the care of the rheumatologists.