Retinal Vessel Oxygen Saturation in Giant Cell Arteritis Patients without Ocular Symptoms

Abstract

Background: The aim of this study was to determine subclinical ocular ischemia related to giant cell arteritis (GCA) by means of retinal oximetry (RO) measurements.

Patients and Methods: Four test-retest RO images per eye were taken with the retinal vessel analyser (IMEDOS Systems UG, Jena). RO measurements in arterial (A-SO₂) and venous (V-SO₂) retinal vessels and their difference (A−V SO₂) were calculated in GCA patients and compared to those of age-matched controls.

Results: GCA biopsy and duplex sonography positive patients (n = 8, 13 eyes) from the Basler Riesenzellarteriitis Kohorte study (BARK) were recruited. In controls (n = 6, 10 eyes), the mean (± SD) A-SO₂ and V-SO₂ were measured at 93.89 % (± 3.0) and at 55.60 % (± 3.4), respectively. In the GCAs, a reduction in the A-SO₂ to 93.37 % (± 3.3) and an increase in V-SO₂ to 61.13 % (± 3.6) were found. The A − V SO₂ difference was reduced in the GCAs to 32.24 % (± 3.8) whereas in the controls the difference was 38.31 % (± 2.8).

Conclusions: Oxygen metabolism is affected in cases with GCA. Thus, RO may provide additional data in the diagnosis of GCA, even when no ophthalmic symptoms have been reported.

Zusammenfassung

Hintergrund: Die Fragestellung besteht darin herauszufinden, ob eine subklinische okulare Ischämie der retinalen Gefäße bei Patienten mit Riesenzellarteriitis (GCA) besteht. Die Messung erfolgte mittels retinaler Oxymetrie (RO).

Material und Methoden: Pro Auge wurden 4 Aufnahmen zur RO mittels Retinal Vessel Analyser (IMEDOS Systems UG, Jena) durchgeführt. RO-Messungen wurden in arteriellen (A-SO₂) und venösen (V-SO₂) Gefäßen durchgeführt sowie deren Differenz (A − V SO₂) berechnet. Die Ergebnisse wurden mit denen der Normalbevölkerung verglichen.

Ergebnisse: Biopsie- und sonografiepositive GCA-Patienten (n = 8, 13 Augen) aus unserer Basler Riesenzellarteriitis-Kohorte-(BARK-)Studie wurden rekrutiert. In der Kontrollgruppe (n = 6, 10 Augen) waren die A-SO₂- und V-SO₂-Mittelwerte (± SD) bei 93,89 % (± 3,0) und 55,60 % (± 3,4). In der GCA-Gruppe war die A-SO₂ auf 93,37 % (± 3,3) reduziert und die V-SO₂ auf 61,13 % (± 3,6) erhöht. Im Vergleich zu den Kontrollprobanden (38,31; ± 2,8), war die A − V SO₂-Differenz in der GCA-Gruppe entsprechend auf 32,24 % (± 3,8) reduziert.

Schlussfolgerung: Unsere Ergebnisse weisen daraufhin, dass der Sauerstoffmetabolismus bei den Patienten mit GCA beeinflusst ist. Die RO kann also eine wichtige Rolle bei der Diagnose der GCA spielen, auch bei ophthalmologisch asymptomatischen Fällen.

Key words

giant cell arteritis - retinal oximetry - retinal vessel saturation

Schlüsselwörter

Riesenzellarteriitis - retinale Oxymetrie - Sauerstoffsättigung der retinalen Gefäße

• References

• 1 Chatelain D, Duhaut P, Schmidt J et al. Pathological features of temporal arteries in patients with giant cell arteritis presenting with permanent visual loss. Ann Rheum Dis 2009; 68: 84-88
• 2 Gonzalez-Gay MA, Vazquez-Rodriguez TR, Lopez-Diaz MJ et al. Epidemiology of giant cell arteritis and polymyalgia rheumatica. Arthritis Rheum 2009; 61: 1454-1461
• 3 Hunder GG, Bloch DA, Michel BA et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 1990; 33: 1122-1128
• 4 Luqmani RA, Suppiah R, Grayson PC et al. Nomenclature and classification of vasculitis – update on the ACR/EULAR diagnosis and classification of vasculitis study (DCVAS). Clin Exp Immunol 2011; 164: 11-13
• 5 González-Gay MA, García-Porrúa C, Llorca J et al. Visual manifestations of giant cell arteritis. Trends and clinical spectrum in 161 patients. Medicine (Baltimore) 2000; 79: 283-292
• 6 Hayreh SS, Podhajsky PA, Zimmerman B. Ocular manifestations of giant cell arteritis. Am J Ophthalmol 1998; 125: 509-520
• 7 Glutz von Blotzheim S, Borruat FX. Neuro-ophthalmic complications of biopsy-proven giant cell arteritis. Eur J Ophthalmol 1997; 7: 375-382
• 8 Kawasaki A, Purvin V. Giant cell arteritis: an updated review. Acta Ophthalmol 2009; 87: 13-32
• 9 Haering M, Holbro A, Todorova MG et al. Incidence and prognostic implications of diplopia in patients with giant cell arteritis. J Rheumatol [in press]
• 10 Lopez-Diaz MJ, Llorca J, Gonzalez-Juanatey C et al. The erythrocyte sedimentation rate is associated with the development of visual complications in biopsy-proven giant cell arteritis. Semin Arthritis Rheum 2008; 38: 116-123
• 11 Hayreh SS, Zimmerman B, Kardon RH. Visual improvement with corticosteroid therapy in giant cell arteritis. Report of a large study and review of literature. Acta Ophthalmol Scand 2002; 80: 355-367
• 12 Schweitzer D, Thamm E, Hammer M et al. A new method for the measurement of oxygen saturation at the human ocular fundus. Int Ophthalmol 2001; 23: 347-353
• 13 Hammer M, Thamm E, Schweitzer D. A simple algorithm for in vivo ocular fundus oximetry compensating for non-haemoglobin absorption and scattering. Phys Med Biol 2002; 47: 233-238
• 14 Geirsdottir A, Palsson O, Hardarson SH et al. Retinal vessel oxygen saturation in healthy individuals. Invest Ophthalmol Vis Sci 2012; 13: 5433-5442
• 15 Hardarson SH, Basit S, Jonsdottir TE et al. Oxygen saturation in human retinal vessels is higher in dark than in light. Invest Ophthalmol Vis Sci 2009; 50: 2308-2311
• 16 Olafsdottir OB, Hardarson SH, Gottfredsdottir MS et al. Retinal oximetry in primary open-angle glaucoma. Invest Ophthalmol Vis Sci 2011; 52: 6409-6413
• 17 Hardarson SH, Stefánsson E. Retinal oxygen saturation is altered in diabetic retinopathy. Br J Ophthalmol 2012; 96: 560-563
• 18 Boeckaert J, Vandewalle E, Stalmans I. Oximetry: recent insights into retinal vasopathies and glaucoma. Bull Soc Belge Ophtalmol 2012; 319: 75-83
• 19 Hardarson SH. Retinal oximetry. Acta Ophthalmol 2013; 91: 1-47
• 20 Hardarson SH, Elfarsson A, Agnarsson BA et al. Retinal oximetry in central retinal artery occlusion. Acta Ophthalmol 2013; 91: 189-190
• 21 Valmaggia C, Speiser P, Bischoff P et al. Indocyanine green versus fluorescein angiography in the differential diagnosis of arteritic and nonarteritic anterior ischemic optic neuropathy. Retina 1999; 19: 131-134
• 22 Vollrath-Junger C, Gloor B. Why perform Doppler sonography before every biopsy of the temporal artery?. Klin Monatsbl Augenheilkd 1989; 195: 169-171
• 23 Pfadenhauer K, Weber H. Ultrasonography of the temporal, periorbital and carotid arteries in the diagnosis of giant cell arteritis and its neuroophthalmological complications. Ultraschall Med 2006; 27: 329-335
• 24 Geiger J, Ness T, Uhl M et al. Involvement of the ophthalmic artery in giant cell arteritis visualized by 3T MRI. Rheumatology (Oxford) 2009; 48: 537-541
• 25 Fraser JA, Weyand CM, Newman NJ et al. The treatment of giant cell arteritis. Rev Neurol Dis 2008; 5: 140-152
• 26 Weyand CM, Ma-Krupa W, Goronzy JJ. Immunopathways in giant cell arteritis and polymyalgia rheumatica. Autoimmun Rev 2004; 3: 46-53