Rare presentation of giant cell arteritis in Chinese subjects
Reviewed by Claire Howard

Only a few case reports of biopsy-proven GCA (BpGCA)-associated vision loss in Chinese subjects have been published. This paper presents three elderly Chinese subjects with BpGCA who presented with vision loss. A search of the literature was also conducted to review BpGCA-associated blindness in Chinese subjects. Case 1 presented as simultaneous right ophthalmic artery occlusion and left anterior ischaemic optic neuropathy (AION). Case 2 presented as sequential bilateral AION. Case 3 presented as bilateral posterior ischaemic optic neuropathy and ocular ischaemic syndrome (OIS). The diagnosis was confirmed by temporal artery biopsy in all three. Magnetic resonance imaging (MRI) in Cases 1 and 2 demonstrated retrobulbar optic nerve ischaemia. Enhancement of the optic nerve sheath and inflammatory changes of the ophthalmic artery on enhanced orbital MRI were also noted in Cases 2 and 3. All of the subjects were treated with steroids, either intravenously or orally. In the literature review, 11 cases (17 eyes) of BpGCA-associated vision loss in Chinese subjects were found including AION, central retinal artery occlusion, combined AION and cilioretinal artery occlusion, and orbital apex syndrome. In the 14 cases (including the three presented in this paper), the median age at diagnosis was 77 years, and nine (61.5%) were males. The most common extraocular manifestations were temporal artery abnormalities, headache, jaw claudication and scalp tenderness. Thirteen (56.5%) eyes had visual acuity of no light perception at the initial visit and failed to respond to the treatment. Although rare, in elderly Chinese subjects with ocular ischaemic diseases, the diagnosis of GCA should be considered. Timely aggressive treatment may help to prevent further blindness. The authors conclude that more extensive studies are needed to clarify the incidence and clinical features of GCA-associated visual loss in those of Chinese ethnicity.

Biopsy-proven giant cell arteritis associated vision loss in Chinese subjects: a case series and review of the literature.
Yan Y, Li Z, Luo Y, et al.
NEURO-OPHTHALMOLOGY
2023;47(2):79-87.