PO:37:263 | First non invasive visualization of vasculitis in the retinal arteries by high resolution optical coherence tomography in a patient with giant cell arteritis

Ruggiero Mascolo¹, Chiara Facoetti¹, Claudia Nardi², Stefano Erba², Martina Martelli¹, Gabriella Marinaro¹, Giulia Dieguez¹, Giacomo Iacomelli¹, Chiara Carollo¹, Michel Chevallard³, Bruno Lucchino³, Mariaeva Romano³, Andrea Locatelli³, Donatella Ventura³, Giovanna Randisi³, Giuliana La Paglia³, Alessandra Mutti³, Alessandro Invernizzi², Stefano De Angelis², Giovanni Staurenghi², Antonio Brucato⁴, Enrico Tombetti⁴. | ¹Dipartimento di Medicina Interna, ASST Fatebenefratelli-Sacco, Università degli studi di Milano, Milano, Italy; ²U.O. Oftalmologia, ASST Fatebenefratelli-Sacco, Università degli studi di Milano, Milano, Italy; ³U.O. Reumatologia, ASST Fatebenefratelli-Sacco, Università degli studi di Milano, Milano, Italy; ⁴Dipartimento di scienze cliniche e biomediche, ASST Fatebenefratelli-Sacco, Università degli studi di Milano, Milano, Italy.

Background. Giant cell arteritis (GCA) is an idiopathic vasculitis affecting the large- and medium-sized arteries of the elderly. GCA is characterized by systemic inflammation and patchy arterial inflammation resulting in arterial wall thickening and potential remodelling with stenosis/occlusion or aneurysms. Accordingly, GCA may be complicated by end-organ ischemia, especially in the eye, due to arteritic ischemic optic neuropathy, occlusion of central retinal artery (CRAO) or of one of its branches. Optical coherence tomography (OCT) is an imaging technique that exploits interferometry with short-coherence-length light to characterize the tissues on the micron scale, allowing to visualize retinal features and thickness. High resolution OCT (HR-OCT) is an evolution of OCT not yet available on the market. It has a higher spatial resolution tha traditional OCT. Being potentially able to characterize the arterial walls of the branches of the central retinal artery, HR-OCT is being developed to study retinal vasculopathies. Here we present the first case of GCA with visual involvement (specifically CRAO), evaluated with HR-OCT.

Case Report. An 80 year old woman with history of hypertension, dyslipidemia, diverticolitis, and crhonic headache, present to the emergency room in March 2024 for visual loss. She refers that her chronic headhace had changed since the spring of 2023, affecting the temporal area bilaterally and being more prevalent in the morning. The patient also reported astenia for 6-12 months, worsening exertional dyspnea for 5-6 months and blurred vision for 2-3 months, for which she had a diagnosis of cataract. On the 21st of February 2024 the patient experienced loss of vision from the left eye for which she went to the ER of another hospital, and was diagnosed with CRAO. The patient was discharged with prescription of blood test which showed an ESR of 39 mm/h and a CRP of 76 mg/L. On the 4th of March 2024 GCA was suspected and the patient was referred to our center. The diagnosis was confirmed and she was treated with intravenous methylprednisone 1000 mg for three days, followed by oral prednisone 50 mg which was gradually tapered. High resolution-OCT was performed four days after the initial presentation showed a recanalization of the left retinal artery, with a thickened arterial wall as compared to the controlateral eye. Follow-up after one week showed an improvement in the arterial wall thickening.

Conclusions. A novel semeiologic sign of GCA involvement in the branches of the retinal artery by HR-OCT is reported for the first time. This non-invasive finding is promising for its much higher spatial accuracy as compared to temporal artery ultrasonography or angio-CT/MR. However, the technique is not yet standardized and more data are required to assess its clinical relevance.