Ischaemic optic neuropathy (ION) is a major cause of blindness. The clinical approach and management is a matter of debate for the treating neurologist and the ophthalmologist. Of the two broad varieties namely the posterior (PION) and anterior ischaemic optic neuropathy (AION), the arteritic variety of the AION (AAION) is usually due to giant cell arteritis. Giant cell arteritis may only present with visual loss in up to 25% of cases. AAION is a neuro-ophthalmic emergency. Early recognition and differentiation from AAION is imperative in order to prevent further devastating visual loss. A literature search was conducted on pubmed using key words as AAION, arteritic anterior ischaemic optic neuropathy, giant cell arteritis (GCA) and articles from the year 2000 till date were included. In any case very few reviews are available on AAION. The literature search on pubmed provided holistic overview about this clinical significant entity and the same is compiled in this review. Moreover the histopathologic features of a temporal artery biopsy have been described with its microscopic images. In any case reviews are mostly available on the Non arteritic variety of AION. This review recapitulates the diagnostic and management protocol of a patient presenting with AAION.
HayrehSS.Management of ischemic optic neuropathies. Indian J Ophthalmol2011; 59(2): 123–136.
3.
YoonH-JParkS-WLeeH-K, et al. Bilateral arteritic anterior ischemic optic neuropathy associated with giant cell arteritis in Korea. Korean J Ophthalmol2017; 31(5): 466–467.
BorchersATGershwinME. Giant cell arteritis: a review of classification, pathophysiology, geoepidemiology and treatment. Autoimmun Rev2012; 11(6–7): A544–A554.
6.
PereiraLSYoonMKHwangTN, et al. Giant cell arteritis in Asians: a comparative study. Br J Ophthalmol2011; 95(2): 214–216.
7.
RoupieALde BoyssonHThietartS, et al. Giant-cell arteritis associated with myelodysplastic syndrome: French multicenter case control study and literature review. Autoimmun Rev2020; 19(2): 102446.
8.
González-GayMABlancoRRodríguez-ValverdeV, et al. Permanent visual loss and cerebrovascular accidents in giant cell arteritis: predictors and response to treatment. Arthritis Rheum1998; 41(8): 1497–1504.
9.
HartCT.Formed visual hallucinations: a symptom of cranial arteritis. Br Med J1967; 3(5566): 643–644.
10.
SonnenblickMNesherRRozenmanY, et al. Charles Bonnet syndrome in temporal arteritis. J Rheumatol1995; 22(8): 1596–1597.
11.
NesherGNesherRRozenmanY, et al. Visual hallucinations in giant cell arteritis: association with visual loss. J Rheumatol2001; 28(9): 2046–2048.
12.
TuckwellKCollinsonNDimonacoS, et al. Newly diagnosed vs. Relapsing giant cell arteritis: baseline data from the GiACTA trial. Semin Arthritis Rheum2017; 46(5): 657–664.
13.
SalvaraniCCantiniFBoiardiL, et al. Polymyalgia rheumatica and giant-cell arteritis. N Engl J Med2002; 347(4): 261–271.
14.
El-DairiMAChangLProiaAD, et al. Diagnostic algorithm for patients with suspected giant cell arteritis. J Neuroophthalmol2015; 35(3): 246–253.
15.
Gonzalez-GayMABarrosSLopez-DiazMJ, et al. Giant cell arteritis: disease patterns of clinical presentation in a series of 240 patients. Medicine (Baltimore)2005; 84(5): 269–276.
16.
SaitMRLeporeMKwasnickiR, et al. The 2016 revised ACR criteria for diagnosis of giant cell arteritis – our case series: can this avoid unnecessary temporal artery biopsies?Int J Surg Open2017; 9: 19–23.
HayrehSS.Ischaemic optic neuropathy. Indian J Ophthalmol2000; 48(3): 171.
19.
Danesh-MeyerHVSavinoPJSergottRC.The prevalence of cupping in end-stage arteritic and nonarteritic anterior ischemic optic neuropathy. Ophthalmology2001; 108(3): 593–598.
20.
Danesh-MeyerHVBolandMVSavinoPJ, et al. Optic disc morphology in open-angle glaucoma compared with anterior ischemic optic neuropathies. Invest Ophthalmol Vis Sci2010; 51(4): 2003–2010.
21.
BrennanDNUngprasertPWarringtonKJ, et al. Smoking as a risk factor for giant cell arteritis: a systematic review and meta-analysis. Semin Arthritis Rheum2018; 48(3): 529–537.
22.
UngprasertPKosterMJWarringtonKJ.Coronary artery disease in giant cell arteritis: a systematic review and meta-analysis. Semin Arthritis Rheum2015; 44(5): 586–591.
23.
UngprasertPThongprayoonCKittanamongkolchaiW, et al. Peripheral arterial disease in patients with giant cell arteritis: a meta-analysis. Int J Rheum Dis2016; 19(8): 819–825.
24.
Pujades-RodriguezMDuyxBThomasSL, et al. Associations between polymyalgia rheumatica and giant cell arteritis and 12 cardiovascular diseases. Heart Br Card Soc2016; 102(5): 383–389.
25.
LiLNeogiTJickS.Giant cell arteritis and vascular disease-risk factors and outcomes: a cohort study using UK Clinical Practice Research Datalink. Rheumatology (Oxford)2017; 56(5): 753–762.
26.
KermaniTASchmidtJCrowsonCS, et al. Utility of erythrocyte sedimentation rate and C-reactive protein for the diagnosis of giant cell arteritis. Semin Arthritis Rheum2012; 41(6): 866–871.
27.
CostelloFZimmermanMBPodhajskyPA, et al. Role of thrombocytosis in diagnosis of giant cell arteritis and differentiation of arteritic from non-arteritic anterior ischemic optic neuropathy. Eur J Ophthalmol2004; 14(3): 245–257.
28.
ForoozanRDanesh-MeyerHSavinoPJ, et al. Thrombocytosis in patients with biopsy-proven giant cell arteritis. Ophthalmology2002; 109(7): 1267–1271.
29.
InancMTekinKBudakogluO, et al. Could platelet indices and neutrophil to lymphocyte ratio be new biomarkers for differentiation of arteritic anterior ischemic neuropathy from non-arteritic type?Neuroophthalmol2018; 42(5): 287–294.
30.
KimMKKimUS.Analysis of fundus photography and fluorescein angiography in nonarteritic anterior ischemic optic neuropathy and optic neuritis. Korean J Ophthalmol2016; 30(4): 289–294.
31.
BalducciNMoraraMVeroneseC, et al. Optical coherence tomography angiography in acute arteritic and non-arteritic anterior ischemic optic neuropathy. Graefes Arch Clin Exp Ophthalmol2017; 255(11): 2255–2261.
32.
PierroLArrigoAAragonaE, et al. Vessel density and vessel tortuosity quantitative analysis of arteritic and non-arteritic anterior ischemic optic neuropathies: an optical coherence tomography angiography study. J Clin Med2020; 9(4): 1094.
33.
RougierM-BGattoussiSLe-GoffM, et al. OCT angiography analysis in acute non-arteritic anterior ischemic optic neuropathy: the importance of segmentation. Eur J Ophthalmol. Epub ahead of print 14 December 2020. DOI: 10.1177/1120672120978358.
34.
AschwandenMDaikelerTKestenF, et al. Temporal artery compression sign–a novel ultrasound finding for the diagnosis of giant cell arteritis. Ultraschall Med Stuttg Ger2013; 34(1): 47–50.
35.
AschwandenMImfeldSStaubD, et al. The ultrasound compression sign to diagnose temporal giant cell arteritis shows an excellent interobserver agreement. Clin Exp Rheumatol2015; 33(2Suppl 89): S-113-115.
36.
Mohammed-BrahimNClavelGCharbonneauF, et al. Three Tesla 3D high-resolution vessel wall MRI of the orbit may differentiate arteritic from nonarteritic anterior ischemic optic neuropathy. Invest Radiol2019; 54(11): 712–718.
37.
SommerNNTreitlKMCoppenrathE, et al. Three-dimensional high-resolution black-blood magnetic resonance imaging for detection of arteritic anterior ischemic optic neuropathy in patients with giant cell arteritis. Invest Radiol2018; 53(11): 698–704.
38.
D’SouzaNMMorganMLAlmarzouqiSJ, et al. Magnetic resonance imaging findings in giant cell arteritis. Eye2016; 30(5): 758–762.
39.
MorottiALiberiniPPadovaniA.Bilateral optic perineuritis as the presenting feature of giant cell arteritis. BMJ Case Rep2013; 2013: bcr2011007959.
ByonISJungJHKimHY, et al. Optic perineuritis secondary to acute retinal necrosis. J Neuroophthalmol2013; 33(4): 419–421.
43.
ArnoldAC.Ischemic optic neuropathies. Ophthalmol Clin North Am2001; 14(1): 83–98.
44.
ChevaletPBarrierJHPottierP, et al. A randomized, multicenter, controlled trial using intravenous pulses of methylprednisolone in the initial treatment of simple forms of giant cell arteritis: a one year followup study of 164 patients. J Rheumatol2000; 27(6): 1484–1491.
MazlumzadehMHunderGGEasleyKA, et al. Treatment of giant cell arteritis using induction therapy with high-dose glucocorticoids: a double-blind, placebo-controlled, randomized prospective clinical trial. Arthritis Rheum2006; 54(10): 3310–3318.
47.
ArnoldACLevinLA.Treatment of ischemic optic neuropathy. Semin Ophthalmol2002; 17(1): 39–46.
48.
MahrADJoverJASpieraRF, et al. Adjunctive methotrexate for treatment of giant cell arteritis: an individual patient data meta-analysis. Arthritis Rheum2007; 56(8): 2789–2797.
49.
SteigerwaltRDCesaroneMRBelcaroG, et al. Arteritic anterior ischemic optic neuropathy treated with intravenous prostaglandin E1 and steroids. Int J Angiol2010; 19(03): e113–e115.
50.
SteigerwaltRDBelcaroGVChristopoulosV, et al. Ocular and orbital blood flow velocity in patients with peripheral vascular disease and diabetes treated with intravenous prostaglandin E1. J Ocul Pharmacol Ther2001; 17(6): 529–535.
51.
VilligerPMAdlerSKuchenS, et al. Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial. Lancet2016; 387(10031): 1921–1927.
52.
Calderón-GoerckeMLoriceraJAldasoroV, et al. Tocilizumab in giant cell arteritis. Observational, open-label multicenter study of 134 patients in clinical practice. Semin Arthritis Rheum2019; 49(1): 126–135.
53.
UnizonySMcCulleyTJSpieraR, et al. Clinical outcomes of patients with giant cell arteritis treated with tocilizumab in real-world clinical practice: decreased incidence of new visual manifestations. Arthritis Res Ther2021; 23(1): 8.
54.
MollanSPSharrackNBurdonMA, et al. Aspirin as adjunctive treatment for giant cell arteritis. Cochrane Database Syst Rev2014; 8: CD010453.
55.
LeeMSSmithSDGalorA, et al. Antiplatelet and anticoagulant therapy in patients with giant cell arteritis. Arthritis Rheum2006; 54(10): 3306–3309.
56.
NesherGBerkunYMatesM, et al. Low-dose aspirin and prevention of cranial ischemic complications in giant cell arteritis. Arthritis Rheum2004; 50(4): 1332–1337.
57.
SalvaraniCDella BellaCCiminoL, et al. Risk factors for severe cranial ischaemic events in an Italian population-based cohort of patients with giant cell arteritis. Rheumatol (Oxford)2009; 48(3): 250–253.
58.
NarváezJBernadBGómez-VaqueroC, et al. Impact of antiplatelet therapy in the development of severe ischemic complications and in the outcome of patients with giant cell arteritis. Clin Exp Rheumatol2008; 26(3Suppl 49): S57–S62.
