First Author: C.Keskini GREECE
Co Author(s): P. Kalouda G. Karagiannidis-Stampoulis E. Kanonidou
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This is a case report aiming to present the rapid and manifest visual field deterioration of a primary open angle glaucoma patient with a new-onset bilateral arteritic anterior ischaemic optic neuropathy (AAION) as first sign of giant cell arteritis (GCA).
Department of Ophthalmology, ''Hippokrateion'' General Hospital of Thessaloniki, Thessaloniki, Greece
A 79-year old woman visited the ophthalmology emergency room due to sudden, painless visual loss of the left eye that was installed 2 days ago. The clinical examination findings were: • Visual Acuity (VA): Right Eye (OD) → 0.1 LogMAR cc (no improvement)/ Left Eye (OS) → Hand Motion sc (no improvement) • Fundoscopy: OD → normal findings/ OS → Optic disc edema with chalk white appearance • RAPD (+) OS From the laboratory tests: ESR= 75mm/h The patient did not mention any other symptoms such as new onset headache or pain in the jaw associated with chewing.
The patient was immediately hospitalized and a high-dose intravenous treatment with corticosteroids (methyprednisolone) was initiated. The starting dose was 1g IV for 3 days. A left temporal artery biopsy was obtained and the result was positive. During the second day of hospitalization in the process of clinical examination a visual impairment of the right eye was noticed as well, with a visual acuity of 0.7 LogMAR. Fundoscopic findings of the right eye were optic disc edema in the presence of a flame shaped haemorrhage in the peripapillary area. Visual Field tests were performed. A defect of a blind spot enlargement (MD=22.4) was presented in the right eye’s visual field while the left eye had a complete visual field loss (MD=25.9). The last visual filed test that the patient had performed (one year before the AAION onset) presented glaucomatous defects of the right eye (nasal step, MD=3.4) while the left eye had a normal visual field with an MD= 4.1.
The AAION as the first sign of giant cell arteritis in a patient with Primary Open Angle Glaucoma has led to a rapid and manifest deterioration of the patient’s visual field tests. In patients presenting in the emergency room with an anterior ischaemic optic neuropathy GCA should always be a part of the differential diagnosis due to increased and immediate risk of bilateral involvement.