Correlation between Ultra-Wide-Field Retinal Imaging Findings and Vascular Supra-Aortic Changes in Takayasu Arteritis

Abstract

(1) Background: Takayasu arteritis (TA) is a chronic inflammatory large-vessel vasculitis. Ultra-wide-field imaging allows describing the retinal lesions in these patients and correlating them with vascular supra-aortic stenosis. (2) Methods: In total, 54 eyes of 27 patients diagnosed with TA were included, and a complete ophthalmological examination was performed, including UWF color fundus photography (UWF-CFP), fluorescein angiography (UWF-FA), and computed tomography angiography measuring supra-aortic stenosis. Eleven patients underwent Doppler ultrasound imaging assessing the blood flow velocity (BFV) in the central retinal artery (CRA). (3) Results: Microaneurysms were detected in 18.5% of eyes on fundus examination, in 24.4% of eyes on UWF-CFP, and in 94.4% of eyes on UWF-FA. The number of microaneurysms significantly correlated with the presence of an ipsilateral supra-aortic stenosis (p = 0.026), the presence of hypertension (p = 0.0011), and the duration of the disease (p = 0.007). The number of microaneurysms per eye negatively correlated with the BFV in the CRA (r = -0.61; p = 0.003). (4) Conclusions: UWF-FA improved the assessment of TA-associated retinal findings. The significant correlation between the number of microaneurysms and the BFV in the CRA gives new insight to our understanding of Takayasu retinopathy. The total number of microaneurysms could be used as an interesting prognostic factor for TA.

Keywords: Takayasu; arteritis; hypoperfusion; microaneurysm; ultra-wide-field imaging.

Figure 1

Forty-six-year-old patient with Takayasu arteritis with a history of carotid-carotid bypass and right internal carotid occlusion. (A,B): Ultra-wide-field color fundus photography (UWF-CFP) showing several punctiform hemorrhages in the temporal periphery. (C,D): Intermediate-phase ultra-wide-field fluorescein angiography (UWF-FA) revealing numerous peripheral microaneurysms in both eyes. (E,F): Close-up images of the right eye peripheral retina showing retinal hemorrhages and microaneurysms around a terminal vein. The high number of microaneurysms is associated with non-perfusion areas in the far periphery. (G,H): Close-up images of the left eye peripheral retina with visible peripheral microaneurysms. Capillary non-perfusion areas and a high number of microaneurysms are seen in the UWF-FA close-up. Doppler ultrasound of the right ophthalmic artery (I) and the left ophthalmic artery (J) shows a significant reduction in blood flow velocity.

Figure 2

Seventy-one-year-old patient with Takayasu arteritis with a history of previous aortic and carotid thrombosis. (A): Ultra-wide-field color fundus photography (UWF-CFP) showing a mild venous dilation without hemorrhage or sign of vein occlusion. (B): Multiple arterio- and veno-venous shunts are visible on ultra-wide-field fluorescein angiography (yellow arrows). Arteries are marked with the letter “A” and veins are marked with the letter “V”. A peripheral venous dilation is visible as well as large areas without capillaries.

Figure 3

Correlation between the total number of microaneurysms and the mean blood flow velocity in the retinal central artery (RCA) using the Spearman correlation (r = −0.61, p = 0.0031).