The clinical and ocular manifestations of Takayasu arteritis

To evaluate the clinical and ocular manifestations of Takayasu arteritis and the fundus fluorescein angiography (FFA) characteristics of Takayasu retinopathy (TR).

Medical records and fundus fluorescein angiograms of 156 eyes of 78 patients with Takayasu arteritis were reviewed. Fundus FA using a wide-field fundus camera (60 degrees) was performed in 19 patients, and conventional angiography or spiral computed tomographic angiography was performed in all 78 patients.

The series included 67 female and 11 male patients; mean age at time of diagnosis was 26.7 years (range, 4-61 years). Hypertension was found in 44 (56.4%) patients, ischemic cerebrovascular symptoms in 18 (23.1%) patients, and amaurosis fugax in 20 (25.6%) patients. On fundus examination, no retinopathy was found in 87 (55.8%) eyes; hypertensive retinopathy was found in 48 (30.8%) eyes; and TR was found in 21 (13.5%) eyes. Patients with TR had carotid artery or aortic arch involvement, and patients with hypertensive retinopathy had involvement of the descending aorta or renal artery and sparing of the carotids. Best-corrected visual acuity in TR Stage 1 to 3 ranged from 20/15 to 20/30, but in Stage 4, it ranged from 20/200 to hand motions because of secondary ocular complications. On FFA, the arm-to-retina circulation time was prolonged in all 21 eyes with TR (mean, 22.7+/-8.9 seconds), but only 14 eyes showed delayed arteriovenous filling time, which was mainly found in chronic, moderate to severe TR, Stage 3 or 4. Arteriovenous anastomosis was found in all 12 eyes with Stage 3 and 4 TR.

Delayed arm-to-retina circulation time is shown in all cases of TR, but delayed arteriovenous filling time is mostly found in moderate and severe TR. During ophthalmic examination, the delay of arteriovenous filling time and formation of arteriovenous anastomosis must be examined carefully to prevent visual deterioration.