✍ classic presentation
☝rapid onset of monocular vision loss ( marked to CF or HM) with pale disc swelling and marked RAPD in an old female with dull aching unilateral headache and jaw claudication , tenser scalp , weight loss , malaise and fever
✍ usually caused by vasculitis of medium and large sized arteries ( hence the CRA is not affected) short Posterior ciliary arteries ( by GCA )
✍ GCA is almost granulomatous vasculitis affecting white old female usually >65 yrs old ( never seen in children or adults < 50 yrs old )
AAION diagnosis
✍ by clinical picture mentioned above
✍ inflammatory markers
☝ ESR raised
• normal in 20% of cases
• usually > 50 mm/hr
☝ CRP raised
☝ Alkaline phosphate level in serum raised
☝ ANA positive
✍ FFA
☝ delayed or absent filling of the choroidal circulation( choriodal and cilioretinal artery ischemia)
✍ Temporal artery biopsy(definitive diagnosis)
☝ 3 cm long specimen to avoid skip lesions
AAION Occult GCA (not to forget )
✍ Ocular involvement without associated signs and symptoms but with raised ESR and temporal artery biopsy positive for GCA.
✅AAION Treatment
✍aim of treatment is not to improve the VA of affected eye but to save the fellow eye from similar attack within 2 wks duration if not treated ( 20 to 25 % risk of similar attack to fellow eye if not treated )
✍ if there is high suspicion of GCA , treatment with empirical megadose steroid is initiated without delay or waiting result of TAB ( temporal artery biopsy)
✍ Systemic steroids is the main stay.
☝ IV methyl prednisolone 1–2 g/day for 3 days
☝ oral prednisolone 80 mg/day 1st 3 days
☝ oral prednisolone 60 mg for next 3 days
☝ 40 mg for next 4 days
☝ Taper by 5 mg/week till 10 mg/day ( within 6 wks)
☝ Maintenance dose of 10 mg/day for 12 months
☝ Throughout the treatment the signs, symptoms and inflammatory markers ( CRP and ESR) is monitored.
✍ Tocilizumab (Actemra is an immunosuppressive used in RA and JIA ) recently approved for GCA
✍ anti platelets ( aspirin) can be tried
✍ liaise with cardiologist is mandatory