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Thick corneas, large pupils, and a giant problem.

Francesco Pellegrini1, Giovanni Prosdocimo1, Daniela Bonsanto1

  • 1Neuro-Ophthalmology Service, Department of Ophthalmology, "De Gironcoli" Hospital, Conegliano, Treviso, Italy.

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PubMed
Summary

Giant cell arteritis, a rare cause of vision loss, can manifest as corneal decompensation after cataract surgery. Ophthalmologists should suspect this condition in patients with ocular ischemic syndrome.

Keywords:
central retina artery occlusionchoroidal ischemiacorneal edemagiant cell arteritisocular hypotonyocular ischemic syndrome

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Area of Science:

  • Ophthalmology
  • Rheumatology
  • Vascular Inflammation

Background:

  • Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting medium and large arteries.
  • Ocular involvement in GCA can lead to severe visual impairment, including blindness.
  • Cataract surgery is a common procedure, and post-operative complications require careful evaluation.

Observation:

  • An 87-year-old woman developed unilateral corneal edema post-cataract surgery, initially diagnosed as pseudophakic bullous keratopathy.
  • The condition progressed to bilateral corneal edema, mydriasis, and profound vision loss.
  • Neuro-ophthalmic examination revealed bilateral ocular ischemic syndrome.

Findings:

  • Temporal artery biopsy confirmed giant cell arteritis.
  • Corneal decompensation was identified as a rare presenting sign of GCA.
  • The patient experienced complete visual loss due to the ischemic syndrome.

Implications:

  • Corneal decompensation should be recognized as a potential, albeit rare, manifestation of GCA.
  • Ophthalmologists must maintain a high index of suspicion for GCA in patients presenting with unilateral or bilateral ocular ischemic syndrome.
  • Early diagnosis and treatment of GCA are crucial to prevent irreversible vision loss.