Bilateral Ocular ischemia in a patient with Takayasu arteritis.

Takayasu arteritis is a rare autoimmune condition characterized by granulomatous vasculitis, primarily affecting medium and large-sized arteries. It is more common among women and is most frequently observed in individuals of Asian or Mexican descent. This condition results in the fibrous thickening of arterial walls, leading to various vascular obstructions and ischemic changes. The initial symptoms of Takayasu arteritis are often nonspecific. As the disease progresses, signs of arterial occlusion, aneurysm formation, and vascular pain become more evident. One significant complication of Takayasu arteritis is ocular ischemic syndrome, which can result in blindness. A woman in her 50s presented to us with chief complaints of gradual, progressive diminution of vision beginning with the left eye, and eventually involving both eyes. She had a history of a severe headache on the left side and unintentional weight loss in the last 6 months. She denied any history of arthralgia, claudication, convulsion, or syncope. She had multiple outpatient visits in the past 1 year due to her ongoing visual symptoms. On ocular examination, her vision in RE was counting fingers at 2 meters and no perception of light in LE. Intraocular pressure was 8 mmHg in RE and 10 mmHg in LE. An afferent pupillary defect was present. On slit lamp examination, RE revealed a quiet anterior chamber with no iris vascularization. In LE, an intumescent total cataract was present. On fundus examination, neovascularization was present on the disc, and retinal vessels were attenuated in RE. On systemic examination, both brachial and radial pulses were feeble. Blood pressure readings were 130/80 mmHg on the right side and 80/60 mmHg on the left side. Ultrasound examination of LE showed an attached retina. Fundus fluorescein angiography in RE revealed delayed choroidal filling, disc collaterals (, blue arrow), arteriovenous shunts (, red arrow), microaneurysms (, green arrow), and peripheral capillary non-perfusion (CNP) areas. Both the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were elevated. Liver, renal, and thyroid function tests were normal. Serology for antinuclear antibodies (ANA) was positive. A volume rendered image of CT angiography of the head and neck indicated significant narrowing of the right common carotid artery (, red arrow), as well as non-opacification of the proximal right subclavian artery (, blue arrow) and the proximal left subclavian artery (, yellow arrow).