Graupner M. G., Wenkel H.

Department of Ophthalmology, University Erlangen-Nürnberg, D-91054 Erlangen, Schwabachanlage 6

Background: Anterior ischemic optic neuropathy, central artery occlusion, and optic atrophy are common ocular presentations of temporal arteritis. Alterations of choroidal perfusion have rarely been reported.
Patients and methods: In 8 out of 218 patients with biopsy-proven giant cell arteritis a fluorescence angiography had been performed simultaneously to the arterial biopsy. Retrospectively we re-examined the fluorescein angiograms of these patients. The clinical diagnosis of ocular changes had been 1 x anterior ischemic optic neuropathy, 3 x central artery occlusion, 1 x ischemic retinopathy, 1 x Morbus Horton without ocular alterations and in 2 patients age-related macula degeneration.
Results: All fluorescein angiograms showed irregularities of vessel walls and varying caliber of retinal vessels. An irregular and delayed areolar filling of the choroid up to the postvenous phase of the angiogram was seen in 4 patients. Three patients presented a massive delay in arterial retinal filling. Other angiographic features like cotton-wool-spots at the posterior pole (2/8), hyperfluorescence of the optic disc combined with leakage of fluorescein (1/8) were observed less frequently. In the two patients with age-related macula degeneration the findings of fluorescein angiograms led to the suspicion of giant cell arteritis.
Conclusions: The examined group of patients with giant cell arteritis was certainly not representative but showed an interestingly high number of choroidal malperfusion. This might be a typical finding in giant cell arteritis. In patients with acute visual loss and uncommon ophthalmoscopic signs fluorescence angiography may be helpful to identify delayed choroidal filling characteristic for temporal arteritis.

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