Background:Giant cell arteritis (GCA) is the most common form of systemic vasculitis in patients aged 50 years and older.1Visual symptoms such as amaurosis, diplopia, temporary or permanent visual field loss secondary to optic nerve ischemia are common manifestations.2The value of vascular ultrasound of extra-ocular vessels in diagnosing GCA is well established.3However, the role of transocular ultrasound of the central retinal artery in GCA patients has not yet been established.Objectives:To identify changes in flow velocities of the central retinal artery in GCA patients with visual symptoms and controls with transocular high resolution ultrasound.Methods:Prospective analysis of GCA patients with visual symptoms and controls. Ultrasound of the central retinal artery was performed in 18 newly diagnosed consecutive GCA patients with visual symptoms (GCA-group) and 25 controls without ocular pathology. Visual symptoms included amaurosis, diplopia and temporary or permanent visual field loss. For each eye, peak systolic values (PS) and end diastolic values (ED) were recorded. Furthermore, the resistance index of each central retinal artery was measured.Results:Twenty-one of 36 eyes of 18 GCA patients were affected. Therefore 21 central retinal were measured. The control group consisted of 50 central retinal arteries of 25 eye-healthy individuals. The mean age and gender distribution of the GCA-group were 75.6 years (SD± 8.1) with eight females (44 %) and 67 years (SD± 8.9) with twelve females (48%) in the control group. The mean flow velocity of the central retinal artery was PS 12.2 cm/s (SD± 3.5) and ED 3.7 cm/s (SD± 1.2) in the GCA group and PS 14.4 cm/s (SD± 3.2) and ED 5.1 cm/s (SD± 1.6) in the control group. The mean RI was 0.9 (SD± 0.3) in the GCA group and 0.8 (SD± 0.3) in the control group. Mean reduction in flow velocity in the GCA-group was PS 2.1 cm/s (p= 0.039) and ED 1.4 (p= 0.0004) cm/s, while the RI was increased by 0.14 (p= 0.077). The results for PS and ED measurements were statistically significant, while the results for RI were not significant.Conclusion:In GCA patients with ocular symptoms, a reduction of flow velocities of the central retinal artery compared to the eye-healthy control group was found. Results for PS and ED were significant. There seems to be a trend for decreased flow velocities in coexistence with visual symptoms in patients with GCA.References:[1]Warrington KJ, Matteson EL. Management guidelines and outcome measures in giant cell arteritis (GCA). Clin Exp Rheumatol 2007;25:137–41.[2]Chean CS, Prior JA, Helliwell T, et al. Characteristics of patients with giant cell arteritis who experience visual symptoms. Rheumatol Int 2019;39:1789–96.[3]Dejaco C, Ramiro S, Duftner C, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis 2018;77:636–43Figure 1.Transocular ultrasound of an affected eye in giant cell arteritis with reduced flow velocities and increased resistance index.Disclosure of Interests:None declared
Comment on central retinal artery and vein collapse pressure in giant cell arteritis vs non-arteritic anterior ischaemic optic neuropathy