Arteritic anterior ischemic optic neuropathy and cilioretinal artery occlusion induced by giant cell arteritis in Chinese: two cases report

Abstract Background: Vision loss in patients with arteritic anterior ischemic optic neuropathy (A-AION) caused by giant cell arteritis (GCA) is disastrous and GCA is very rare in Asian individuals. We report two Chinese patients presenting with A-AION complicated with cilioretinal artery occlusion (CLAO), and the temporal artery biopsy (TAB) proved the diagnose of GCA.Case presentation: Two elderly male patients presented with sudden vision loss in the right eyes. Fundus examination of the right eyes revealed chalky, white, swollen optic papilla and swollen region of the retina between the macular and the optic disc. OCT showed a thickened nerve fiber layer of the optic disc and an enhanced signal intensity of the nuclear layer between the macular and the optic disc in OCT. OCTA revealed a decreased density of capillaries around the optic disc and non-perfusion of the deep retina between the macula and the optic disc. The laboratory tests included elevated CRP and ESR. Histopathology of the right temporal artery revealed the infiltration of lymphocytes, plasma cells, histiocytes, and multinucleated giant cells. TAB confirmed the diagnosis of GCA-induced A-AION combined with CLAO. They were treated with intravenous methylprednisolone for 6 days and oral prednisone 1 mg/kg/d, which was gradually tapered. The visual acuities of right eyes were improved in both patients at 6 months follow-up.Conclusions: GCA can lead to A-AION combined with CLAO in Chinese patients. OCTA is a noninvasive and convenient procedure that can reveal decreased density of capillaries around the optic disc and non-perfusion of the deep retina between the macula and the optic disc through the detected of retinal microcirculation in patient with GCA-induced A-AION combined with CLAO.