The clinical and ocular manifestations of Takayasu arteritis

Purpose: To evaluate the clinical and ocular manifestations of Takayasu art eritis and the fundus fluorescein angiography (FFA) characteristics of Taka yasu retinopathy (TR). Patients and Methods: Medical records and fundus fluorescein angiograms of 156 eyes of 78 patients with Takayasu arteritis were reviewed. Fundus FA us ing a wide-field fundus camera (60 degrees) was performed in 19 patients, a nd conventional angiography or spiral computed tomographic angiography was performed in ail 78 patients. Results: The series included 67 female and 11 male patients; mean age at ti me 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%) pat ients, and amaurosis fugax in 20 (25.6%) patients. On fundus examination, n o retinopathy was found in 87 (55.8%) eyes; hypertensive retinopathy was fo und 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 hyperte nsive retinopathy had involvement of the descending aorta or renal artery a nd 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-retin a circulation time was prolonged in ail 21 eyes with TR (mean, 22.7 +/- 8.9 seconds), but only 14 eyes showed delayed arteriovenous filling time, whic h was mainly found in chronic, moderate to severe TR, Stage 3 or 4. Arterio venous anastomosis was found in all 12 eyes with Stage 3 and 4 TR. Conclusions: Delayed arm-to-retina circulation time is shown in all cases o f TR, but delayed arteriovenous filling time is mostly found in moderate an d severe TR. During ophthalmic examination, the delay of arteriovenous fill ing time and formation of arteriovenous anastomosis must be examined carefu lly to prevent visual deterioration.