![]() ![]() ![]() He had panretinal endophotocoagulation and intracameral and intravitreal injection of 1.25 Discussion He was placed on prednisolone 60 mg/day, aspirin 100 mg/day, and oral methotrexate 20 mg/week.īecause of opaque media in his left eye, panretinal photocoagulation was not possible, so cataract surgery and pars plana vitrectomy were performed. 2 He had OIS in both eyes and ischemic optic neuropathy in his left eye. This patient fulfills the American College of Rheumatology’s diagnostic criteria for TA. 33 Goel et al had a series of patients with TA who were better Case Report (Concluded) Rodríguez-Hurtado et al’s case of TA with ocular involvement responded to monthly intravenous cyclophosphamide monotherapy. 24 Immunosuppressants such as methotrexate, azathioprine, and mycophenolate mofetil (MM) have been used successfully. Maintenance dosages of at least 15 mg/day are usually required to suppress disease activity. Prednisone, typically started at 0.5–1.0 mg/kg/day, is the mainstay of systemic therapy for TA. Sharma et al proposed revisions to the 1988 diagnostic criteria published by Ishikawa Comments by Dr. 2 Three are needed for diagnosis: 1) age <40 years, 2) extremity claudication, 3) decreased brachial artery pulse, 4) ≥10 mm Hg difference in blood pressure between the arms, 5) subclavian or aortic bruit, and 6) abnormal angiography of the aorta or its proximal branches. In 1990, the American College of Rheumatology proposed six criteria for TA. My diagnosis is bilateral OIS from large vessel involvement in TA. Carotid duplex showed complete bilateral common Comments by Dr. Physical examination revealed bilterally absent radial and carotid pulses, and a bruit was heard in the neck. Neovascularization over the left disc was also evident (Fig. 1E and F). This can be secondary to atherosclerosis, a coagulopathy, or possibly a traumatic lesion Case Report (Continued)įundus fluorescein angiography revealed bilaterally delayed arm to retina time (30 seconds), delayed and patchy choroidal filling, prolonged arteriovenous transit time, microaneurysms in mid-peripheral retina and posterior pole, and peripheral capillary nonperfusion. OIS is caused by severe narrowing of the internal carotid or its branches. With the history and examination, and now syncope and headache indicating intermittent cerebral hypoperfusion, the differential diagnosis may be framed by the usual categories of atherosclerosis or compromise of vascular lumen-either primary or secondary to a coagulopathy-trauma, neoplasm, infection, inflammation, or other (Table 1). In addition to his previously described findings, he also had a dense cataract in his left Comments by Dr. His right pupil reacted poorly, and his left pupil was fixed and dilated. His acuities were 20/40 in his right eye and counting fingers in his left eye. He also reported headache, transient visual loss in his right eye for about 1 minute, and a syncopal attack. He was lost to follow-up until a few weeks later, when he presented to the emergency room with sudden, painless loss of vision in his left eye. ![]() This constellation of signs and symptoms suggests the presence of ocular ischemic syndrome Case Report (Continued) The lack of a RAPD suggests that there was bilateral, relatively symmetric optic nerve involvement, which might be evident upon perimetry. This patient had no significant medical history, and developed iris neovascularization, synechiae (I do not know if uveitis was also present.), mid-peripheral microaneurysms, arteriovenous shunts, optic disc neovascularization, and preretinal and vitreous hemorrhage. Slit lamp examination revealed bilateral Comments by Larry Frohman, MD He had no relative afferent pupillary defect (RAPD), but his pupils reacted sluggishly to light, the left eye more than the right. His best-corrected visual acuity was 20/25 right eye and 20/200 left eye. He had no history of diabetes, hypertension, or other systemic diseases. A 42-year-old man born in Pakistan was referred for a painless, gradual decline in visual acuity over 4 months in both eyes. ![]()
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