Nandhini Arumugam1, Arthi Mohankumar2
Takayasu arteritis is a chronic inflammatory vasculopathy mainly affecting the aorta and its main branches and rarely the pulmonary artery. It usually affects females of the childbearing age group and is more prevalent in the South East Asian countries.1 Ocular manifestations are not uncommon in cases of Takayasu arteritis. They may be ischaemic ocular manifestations when aorta and its branches are involved and get stenosed or hypertensive retinopathy when renal or suprarenal aorta is involved.2 Uyama and Asayama broadly classified the ocular manifestations into three types.3 Type 1 comprised of the ischaemic ocular manifestations of Takayasu arteritis, termed as Takayasu Retinopathy which has been further classified into four stages. Stage one is characterised by the distention of veins, stage two consists of microaneurysm formation, occurrence of arteriovenous anastomoses indicates stage three and complications like retinal ischaemia, neovascularisation, rubeosis iridis and vitreous haemorrhage occurs in stage four. Type two ocular findings have features of mixed retinopathy and type three had retinal manifestations due to hypertension which occurs due to the involvement of the renal and abdominal aorta. Since this disease occurs predominantly in younger individuals it causes severe ocular morbidity in the young if not diagnosed and intervened at an early stage.
The aim of this study was to evaluate the clinical spectrum of ocular findings in patients with Takayasu arteritis and to describe the Fundus Fluorescein angiographic characteristics of various retinal findings in patients with Takayasu arteritis.
MATERIALS AND METHODS
63 patients who were diagnosed as Takayasu Arteritis who attended our tertiary eye care centre in the time period of November 2014 to march 2017 were included in our study.
This cross-sectional study consisted of 63 patients. The mean age of the presentation of the study population was 27.8 years and the mean duration of the disease after which the patient developed eye or eye related symptomatology was 2 years. The commonest ocular manifestation was type 3 Takayasu retinopathy. Other posterior segment manifestations included, Type 1 and Type 3 Takayasu retinopathy, ocular ischaemic syndrome, retinal vasculitis and Anterior ischaemic optic neuropathy. The commonest anterior segment manifestation was posterior sub capsular cataract which was found in 33.3% of the patients. Fundus Fluorescein angiography was performed in 34 patients.
This study is to highlight the fact that Takayasu arteritis can present with multitudinous ocular manifestations which can be hypertensive or hypoperfusive and can lead to significant ocular morbidity if not for timely intervention. This study is to strongly emphasise routine and regular ophthalmic screening in patients with Takayasu arteritis at the time of diagnosis and also at adequate intervals to diagnose significant treatment related complications like steroid induced cataract at an early stage.