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We read with interest Chetalain etal article on pathological features of temporal artery biopsy in patients with Giant cell arteritis and permanent visual loss (PVL).They noted that presence of giant cells,
thickened intima with angiogenesis and intensity of arterial occlusion were significantly associated with blindness.
The neuro- ophthalmic complications of GCA like visual loss or stoke result fr...
The neuro- ophthalmic complications of GCA like visual loss or stoke result from luminal narrowing or occlusion as a direct consequence of intimal hyperplasia. We reported a retrospective study in April 2008 looking at the association between the degrees of luminal narrowing due to intimal hyperplasia and neuro opthlamic complications (NOC). The biopsy samples were assessed by two independent histopathologists blinded to clinical information. In our group of 30 patients with GCA, there was a very significant statistical trend of increasing NOC associated with higher grades of luminal occlusion due to intimal hyperplasia .
We feel that our results as well as the results of Chetalain et al should be confirmed in a prospective study with a systematic record of histological findings on biopsy and blinded re-verification by an independent histopathologist. Such a rigorous documentation of temporal artery biopsy positivity and histological abnormalities will provide opportunity to compare the diagnostic accuracy of biopsy with other tests such as duplex ultrasonography which has also shown utility in the
diagnosis of GCA.
In terms of analysing histological correlation with the clinical symptoms there is a need to include all ischemic complications i.e. partial vision loss, visual field defects and strokes. In the article Chetalain et al noted 35% patients with GCA without PVL had significant
thickening of intima. It would be interesting to find out how many of these patients had visual field defects or cerebral infarcts.
1. D Makkuni, A Bharadwaj, K Wolfe, S Payne, A Hutchings and B Dasgupta. Is intimal hyperplasia a marker of neuro-ophthalmic complications of giant cell arteritis. Rheumatology 2008;47(4):488-490.