RESUMEN
Giant cell arteritis is a challenging diagnosis for patients given the high prevalence of negative temporal artery biopsies (TAB). Despite the lack of histopathological evidence of giant cell arteritis in the TAB, patients can still have TAB-negative giant cell arteritis. The purpose of this paper is to analyse the predictors for TAB-negative giant cell arteritis and the alternative diagnosis of biopsy-negative patients without a giant cell arteritis diagnosis. A retrospective electronic database review of all TABs performed at the Royal Victorian Eye and Ear Hospital from February 2015 to May 2020. Logistic regression analysis was performed to determine predictive factors for a diagnosis of TAB-negative giant cell arteritis. In all cases, a clinical diagnosis of TAB-negative giant cell arteritis was determined by a neuro-ophthalmologist. Alternative diagnoses for negative TABs were identified and explored. A total of 368 TABs were analysed with 287 (78%) negative for histopathological evidence of GCA. Twenty-seven (9.4%) patients were diagnosed and treated as TAB-negative giant cell arteritis. The clinical predictors of a TAB-negative giant cell arteritis diagnosis were the presence of jaw claudication (OR 2.77, 95% CI 1.10-6.98) and CRP (OR 1.02, 95% CI 1.00-1.03). Alternative diagnoses included non-specific headache, non-arteritic anterior ischaemic optic neuropathy, retinal vessel occlusions, and ocular nerve palsies. Predictive factors for a diagnosis of TAB-negative giant cell arteritis were jaw claudication and an elevated CRP. Several alternative diagnoses can be considered for patients with a negative TAB in a neuro-ophthalmology context.
RESUMEN
Nab-paclitaxel-related cystoid macular edema is a rare ophthalmic adverse drug reaction. We present a 54-year-old woman with metastatic hormone receptor positive, HER-2 negative breast carcinoma who developed profound bilateral vision loss after the seventh cycle of nab-paclitaxel treatment. Optical coherence tomography and macula microperimetry demonstrated macular edema and decreased threshold sensitivity, respectively. Cessation of nab-paclitaxel improved structural and functional vision after 4 weeks. The introduction of topical dorzolamide 1% in one eye demonstrated further rapid resolution of edema. We demonstrate the objective and subjective visual changes and recovery of nab-paclitaxel-related cystoid macular edema. [Ophthalmic Surg Lasers Imaging Retina 2024;55:408-411.].