COLOR DOPPLER HEMODYNAMICS OF GIANT-CELL ARTERITIS

Objectives: To determine quantitative and qualitative hemodynamic alte rations within the ophthalmic, central retinal, and short posterior ci liary arteries in patients with giant cell arteritis (GCA) proved by b iopsy specimen. Design, Patients, and Setting: A consecutive case seri es ofpatients with GCA referred to an urban eye hospital who were eval uated with color Doppler imaging that was used to analyze orbital bloo d flow velocities and vascular resistance in 22 consecutive patients w ith GCA compared with age and sex-matched controls. Results: Patients with GCA all demonstrated significantly reduced central retinal and sh ort posterior ciliary arterial mean flow velocities as well as signifi cantly increased vascular resistance compared with matched controls. O phthalmic artery mean flow velocity demonstrated marked variation depe nding on the anatomic location studied. Other color Doppler imaging ch aracteristics of GCA included the following: ophthalmic artery aliasin g (high velocity and turbulent flow at presumed focal vasculitic steno ses), reversal of flow within the ophthalmic artery, reduced and trunc ated time-velocity waveforms of the central retinal and short posterio r ciliary arteries, and absolute deficits of flow within the central r etinal and short posterior ciliary arteries. Aliasing of flow velocity within the ophthalmic artery (two patients) was associated with clini cal progression of GCA. Conclusions: These data support the concept th at quantitative and qualitative alterations in blood flow are pathophy siologic mechanisms of visual loss in GCA. This technique may be usefu l in the diagnosis and management of GCA since some of the color Doppl er waveforms observed in GCA have not been seen in nonarteritic optic neuropathy. Treatment with corticosteroids often appears to stop the p rogression of these hemodynamic abnormalities but generally does not i mprove preexisting vascular abnormalities.