Journal of Vasculitis

Management of Bilateral Ocular Ischemic Syndrome in Takayasu Arteritis: Our Experience and a Brief Review Stressing Need for Multimodal Approach

Abstract

Abilash Krishnan Vijayakumaran, Urmila Dhakad*, Saurabh Kumar, Sayan Mukherjee and Mukesh Maurya

Objectives: To elaborate the presentation of three patients of Takayasu Arteritis type V, who presented with acute onset binocular diminution of vision and discuss various aspects of management in Ocular ischemic syndrome (OIS).

Methods: Three patients satisfying the 1990 ACR classification criteria for Takayasu Arteritis, presented with bilateral acute OIS to a rheumatology clinic at a tertiary care center. They were managed by pharmacotherapy and percutaneous transluminal angioplasty. Our experience of managing these patients and a brief review is elaborated. Prior institutional ethics board approval has been obtained.

Results: All three patients with OIS who did not improve with pharmacotherapy including pulse glucocorticoids, had good improvement in bestcorrected visual acuity (BCVA) after percutaneous transluminal angioplasty involving bilateral internal/ common carotid arteries.

Conclusion: Acute OIS in TA is a vision threatening emergency. In patients who fail to improve on pharmacotherapy, multidisciplinary approach is warranted. Early revascularization procedures can achieve good visual outcome and prevent irreversible damage.