Blindness in a pulseless young woman: lessons learned

Area of Science:

• Ophthalmology
• Rheumatology
• Vascular Medicine

Background:

• Takayasu arteritis (TA) is a rare, chronic inflammatory disease affecting large arteries, primarily the aorta and its branches.
• Ocular ischemic syndrome (OIS) is a condition caused by reduced blood flow to the eye, leading to vision loss.

Observation:

• A case report details a young woman whose initial presentation of Takayasu arteritis was severe visual impairment due to ocular ischemic syndrome.
• Diagnostic imaging revealed significant stenosis in the aortic branches, and fundus fluorescein angiography demonstrated diffuse capillary nonperfusion in the retina.

Findings:

• Despite prompt treatment with intravenous methylprednisolone, oral steroids, and methotrexate, the patient experienced only partial improvement in systemic symptoms.
• Visual recovery was notably poor, highlighting the challenges in managing TA-induced OIS.

Implications:

• This case underscores that ocular ischemic syndrome can be a subtle, early manifestation of Takayasu arteritis.
• It suggests that even with aggressive immunosuppressive therapy, visual outcomes in TA-related OIS can be unfavorable, necessitating further research into novel therapeutic strategies.