The Role of Vascular uUtrasound in Managing Giant Cell Arteritis in Ophthalmology.

TitleThe Role of Vascular uUtrasound in Managing Giant Cell Arteritis in Ophthalmology.
Publication TypeJournal Article
Year of Publication2019
AuthorsChing, J, Smith, SMansfield, Dasgupta, B, Damato, EMarie
JournalSurv Ophthalmol
Date Published2019 Nov 24
ISSN1879-3304
Abstract

Giant cell arteritis (GCA) is the most common systemic vasculitis in the elderly and is a potentially life-threatening ophthalmic emergency that can result in irreversible blindness without prompt treatment. Blindness is most commonly associated with acute onset, irreversible arteritic ischemic optic neuropathy (AION). Without treatment, second eye involvement may occur, resulting in bilateral blindness. Patients with established visual loss are treated with high dose steroids and generally undergo a temporal artery biopsy to confirm their diagnosis. A significant number of patients are, however, referred for urgent ophthalmology assessment from concerns about "incipient" AION. Prior to visual loss, patients may experience a range of ocular symptoms related to ischemia. This generally leads to treatment with high dose systemic steroid and an urgent request for a temporal artery biopsy. Temporal artery biopsy (TAB) is regarded as the standard investigation for confirmatory diagnosis. It is generally arranged as soon as possible, though is often not carried out for several days, and there may also be delays in histopathological reporting. It is perceived that the patient is "safe" while on corticosteroids, in that they are being treated to avoid visual loss. What is often not acknowledged, however, is that if patients do not have GCA and are being treated "just in case," they will often require a tapering of oral steroids over several weeks, exposing them to unnecessary and significant side effects. In the rheumatology setting, vascular ultrasound (US) has emerged as a safe and reliable alternative to TAB as a point of care diagnostic tool in the management of GCA. Given an experienced sonographer and optimal equipment, a rapid diagnosis can be established in a fast track clinic setting, taking into consideration clinical assessment, scoring , and US findings. A huge advantage of US is that it provides immediate information that can be used to inform treatment decisions. We explore the evidence that supports the incorporation of vascular US into the ophthalmology repertoire in order to make a more efficient diagnosis that is cost effective and associated with better patient outcomes, including a potential reduction in loss of sight and avoidance of unnecessary long-term steroid treatment by early exclusion of mimics.

DOI10.1016/j.survophthal.2019.11.004
Alternate JournalSurv Ophthalmol
Citation Key10.1016/j.survophthal.2019.11.004
PubMed ID31775013