AB0383 OCULAR MANIFESTATIONS DURING GIANT CELL ARTERITIS

Background:Horton’s disease (HD) or giant cell arteritis (GCA) is a segmental and plurifocal giant cell inflammatory panarteritis, predominant in large and medium sized vessels. Ocular damage during giant cell arteritis is frequent and is considered the most serious damage, possibly causing blindness in 15% of cases in recent series (1).Objectives:Describe the different ophthalmological manifestations during GCA.Methods:This is a retrospective monocentric descriptive study of 19 files of subjects diagnosed with HD, hospitalized in the internal medicine department of de Sousse between January 2000 and December 2020.Results:The average age of patients at diagnosis was 70 years, with extremes of 53 and 92 years. There were 14 females (71.4%) and 5 males (28.6%). Ophthalmologic manifestations were present in 13 patients (71%), 6 of whom were female.Decreased visual acuity was reported in 8 cases (58.33%) with biolateral blindness in one case, visual blur in 9 cases (75%), eye pain in two cases.Ophthalmological examination was normal in 8 cases (42%). A decrease in visual acuity was objective in 4 cases (21%). One case of nodular episcleritis was noted. The fundus showed anterior ischemic optic neuropathy in 2 cases (10.5%) and left optic atrophy in another case. A visual field was performed in 2 cases showing associated retrobulbar optic neuritis. Therapeutically, Methylprednisolone boli were prescribed in patients with anterior ischemic optic neuropathy, followed by oral corticosteroid therapy at a dose of 1mg/kg/day. A dose of 0.7 mg/kg/day of prednisone was prescribed in the other cases. Blindness was irreversible.Conclusion:The most common eye diseases in HD are acute anterior ischemic optic neuritis, retinal artery occlusion and posterior ischemic optic neuropathy. Episcleritis is a rare ophthalmologic manifestation of this vasculitis (2). More exceptionally, Horton’s disease may cause NORB by affecting the vessels that supply the optic nerve (< 5% of cases)(3,4). In our series of studies, acute anterior ischemic optic neuritis was less observed than in the literature. This is probably due to the reduced number of patients.References:[1]M.Khedher. I.Rachdi. Z.Aydi. F.Daoud. B.Ben Dhaou. F.Boussema. Eye damage during Horton’s disease: about 42 cases. La Revue de Médecine Interne 2017; 38:115.[2]Rim Klii. Wafa Chebbi. Nodular episcleritis: an unusual inaugural manifestation of Horton’s disease. Pan Afr Med J 2015; 21: 20.[3]M.EssouriI.RachdiF.DaoudZ.AydiH.ZoubeidiB.Ben Dhaou et al. Retrobulbar Optic Neuropathy in Internal Medicine. La Revue de Médecine Interne 2018; 39: 132.[4]M A González-Gay, C García-Porrúa, J Llorca, A H Hajeer, F Brañas, A Dababneh et al. Visual manifestations of giant cell arteritis. Trends and clinical spectrum in 161 patients. Medicine (Baltimore) 2000;79(5):283-92.Disclosure of Interests:None declared

An Unusual Presentation of Horton’s Disease

Horton’s disease or temporal giganto cellular arteritis is an inflammatory disease of the vessels, particularly affecting older female. We report the case of a 50-year-old patient with a classic clinical picture of anterior arteritic optic neuropathy with ischemia of the optic nerve, with a horizontal level and hypo-choroidal perfusion of the corresponding territory. The peculiarity in this patient is the negativity of the biological assessment and biopsy of the temporal artery