Bilateral glaucomatous optic neuropathy in Takayasu's disease without cervical arterial stenosis.

Abstract

Although significant decrease in retinal perfusion is usually not observed before all of the cervical arteries became markedly narrowed in patients with Takayasu's disease (TD), we present bilateral glaucomatous optic neuropathy in a patient with TD without any cervical arterial stenosis. Ophthalmoscopic examination disclosed glaucomatous optic neuropathy in both eyes with 7/10-cup/disc ratio in the right eye and 9/10 in the left eye. Left subclavian selective arteriographic examination demonstrated segmental high-grade stenosis, namely 90 percent stenosis in the mid portion of the left subclavian artery. Arteriography, digital subtraction angiography (DSA), magnetic resonance angiography (MRA) and color Doppler sonography revealed patent cervical, carotid interna, ophthalmic, retinal and posterior ciliary arteries. Patient was followed up for 48 months with frequent intervals and there was no deterioration of visual acuity, visual field and optic neuropathy without any antiglaucomatous treatment. Although it is a known fact that classical ophthalmic manifestations of the TD occur only when major cervical arteries are occluded, no occlusion was observed in this patient with bilateral optic atrophy. The optic nerve damage is caused by various factors, but these factors require much elucidation before the optic neuropathy can be understood.