• Langue : Français, Anglais
• Discipline : Médecine. Ophtalmologie
• Identifiant : 2023ULILM162
• Type de thèse : Doctorat de médecine
• Date de soutenance : 23/06/2023

Résumé en langue originale

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Résumé traduit

Aims : to highlight the interest of Optical Coherence Tomography (OCT) and OCT-angiography (OCT-A) for diagnosis of giant cell arteritis (GCA). Methods: retrospective case-series of patients, with early or challenging diagnosis of ocular involvement in GCA. Patients underwent OCT/OCT-A with either Zeiss Cirrus 5000, Plexelite or Heidelberg Spectralis at Lille university or Boulogne-sur-Mer hospitals between 2021 and 2023. Results: Six patients (9 eyes) with visual impairment were selected: 4 arteritic anterior ischemic optic neuropathy (AAION), 2 paracentral acute middle maculopathy (PAMM), and 3 central retinal artery occlusion (CRAO). Among all, there were 9/9 reversible increased retinal thickness (RT), 9/9 radial peripapillary capillary defects, 9/9 diffuse alteration of macular capillary plexus (partial recovery of altered foveolar avascular zone in 5/5 patients), 5/9 ellipsoid zone (EZ) irregularity (3 reversible) or disruption, 6/9 choriocapillaris defects (4 reversible), 4/9 foveal choroidal thickness (FCT) < 250 μm, 5/9 reversible tortuous and dilated vessels. Among CRAO, 3/3 had hyporeflective peri-arterial zones likely corresponding to a “halo sign”. Conclusion: OCT/OCT-A could help diagnose GCA in patients with visual symptoms. It might show indirect signs of choroidal (low FCT, choriocapillaris/choroidal defects) or retinal (diffuse alteration of capillary plexus, variable RT, halo sign and inner retinal hyperreflectivity, EZ irregularity) ischemia occurring during GCA. These early OCT findings pointing towards GCA could prompt vision-saving therapy. Retinal or optic nerve head ischemia occurs in combination in both AAION and PAMM/CRAO in GCA patients making the analysis of both structures crucial to the diagnosis.