Versicherungsmedizin · 2014
[Bilateral loss of vision in temporal arteriitis--a preventable condition?].
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Pfadenhauer K
Аннотация
BACKGROUND: Bilateral loss of vision (BLV) is one of the most feared complications of temporal arteriitis (TA).
AIM: Analysis of factors contributing to BLV.
PATIENTS AND METHODS: Observational study in 301 TA patients in- cluding 23 (8%) suffering from BLV.
RESULTS: Diagnosis of TA was unknown in all patients before BLV. Total blindness of both eyes occurred in 10 and in one eye in 5 patients. BLV evolved simultaneously in 7, sequentially in 12, and time latency remained undetermined in 4 patients. Loss of vision occurred during hospital treatment in 5 patients. Progressive loss of vision despite glucocorticoid treatment was observed in 2 patients with bilateral AION. Warning signs of TA were absent due to atypical manifestation of the disease in 11 patients, and transient visual disturbances preceded BLV only in 5 patients. Typical abnormalities of the temporal artery on palpation were lacking in 11 patients, and ESR was below 50 mm in 5 patients. Co-morbidities were present in all patients, including diseases mimicking TA, other vascular disease and dementia, as an obstacle to correct analysis of the course of the disease. Medical malpractice was claimed and recognised in 2 patients and could not be excluded in other patients.
CONCLUSION: Prevention of BLV due to TA and ischemia of the anterior visual pathways is not pos- sible in all patients because it may occur suddenly and simultaneously without any preceding clinical warning signs.
AIM: Analysis of factors contributing to BLV.
PATIENTS AND METHODS: Observational study in 301 TA patients in- cluding 23 (8%) suffering from BLV.
RESULTS: Diagnosis of TA was unknown in all patients before BLV. Total blindness of both eyes occurred in 10 and in one eye in 5 patients. BLV evolved simultaneously in 7, sequentially in 12, and time latency remained undetermined in 4 patients. Loss of vision occurred during hospital treatment in 5 patients. Progressive loss of vision despite glucocorticoid treatment was observed in 2 patients with bilateral AION. Warning signs of TA were absent due to atypical manifestation of the disease in 11 patients, and transient visual disturbances preceded BLV only in 5 patients. Typical abnormalities of the temporal artery on palpation were lacking in 11 patients, and ESR was below 50 mm in 5 patients. Co-morbidities were present in all patients, including diseases mimicking TA, other vascular disease and dementia, as an obstacle to correct analysis of the course of the disease. Medical malpractice was claimed and recognised in 2 patients and could not be excluded in other patients.
CONCLUSION: Prevention of BLV due to TA and ischemia of the anterior visual pathways is not pos- sible in all patients because it may occur suddenly and simultaneously without any preceding clinical warning signs.