Acute vision loss and choroidal filling delay in the absence of giant-cell arteritis.
Giant-cell arteritis (GCA) is a visually devastating disease that often progresses to severe bilateral vision loss if untreated. Diagnosis of GCA is made challenging by the protean nature of the disease and the lack of a simple test that is both highly sensitive and specific. Choroidal filling delay on fluorescein angiography (FA) has been touted as a highly characteristic feature of GCA-related vision loss, although knowledge of both the sensitivity and specificity of this finding remains unproven. We report our experience of delayed choroidal filling on FA in a series of seven patients referred to an academic neuro-ophthalmology practice due to concern for GCA. Despite the FA findings, our examination, diagnostic testing, and long-term follow-up excluded the diagnosis of GCA in all cases, suggesting that choroidal perfusion abnormalities may occur in the absence of GCA. When evaluating a patient for acute vision loss, the astute clinician must remain cognizant of the limitations of FA in the diagnosis of GCA.
Department of Ophthalmology and Visual Neurosciences, Washington University School of Medicine, St Louis, MO.
Ling
L
Bei
Casey Eye Institute, Oregon Health and Science University, Portland, OR.
Iris
I
Lee
Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA.
Michael S
MS
Lee
Department of Ophthalmology and Visual Neurosciences, Washington University School of Medicine, St Louis, MO.
Greg P
GP
Van Stavern
Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA.
Collin M
CM
McClelland
delayed choroidal filling; fluorescein angiography; giant-cell arteritis
J Clin Neurosci. 2009 Oct;16(10):1263-8
19586772
Semin Arthritis Rheum. 1995 Jun;24(6):422-31
7667646
Arthritis Rheum. 1988 Jun;31(6):745-9
3382448
Retina. 1999;19(2):131-4
10213239
Scott Med J. 1979 Apr;24(2):111-7
493941
Am J Ophthalmol. 1993 Jan;115(1):57-63
8420379
Am J Ophthalmol. 1994 Feb 15;117(2):222-30
8116751
Arthritis Rheum. 2003 Dec;48(12):3522-31
14674004
Eye (Lond). 1990;4 ( Pt 1):25-41
2323477
Am J Ophthalmol. 1994 Jan 15;117(1):81-6
8291597
J Neuroophthalmol. 2015 Sep;35(3):246-53
25802967
Arch Neurol. 2011 Apr;68(4):517-20
21482932
Arthritis Rheum. 1998 May;41(5):778-99
9588729
J Clin Neuroophthalmol. 1991 Dec;11(4):221-7
1838538
Am J Ophthalmol. 1980 Mar;89(3):362-8
7369296
Ophthalmology. 1986 Nov;93(11):1383-400
3808599
Am J Ophthalmol. 2002 Jan;133(1):151-2
11755858
Am J Ophthalmol. 1968 Dec;66(6):1069-74
5727645
Clin Exp Ophthalmol. 2002 Aug;30(4):284-91
12121370
Arch Ophthalmol. 1985 Aug;103(8):1136-42
4026642
Ophthalmology. 2003 Mar;110(3):539-42
12623817
Arch Ophthalmol. 1987 Jul;105(7):939-42
3606453
Ophthalmology. 1994 Nov;101(11):1779-85
7800356
Arch Ophthalmol. 1976 Jun;94(6):1025-35
938279