Microsoft Word - Sharmeen Akram Case Report


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Case Report 
 

Central Serous Retinopathy in A Male 
Patient with Takayasu Disease – A Rare 
Presentation 
 
Sharmeen Akram, Azam Ali, Khabir Ahmad 
 

Pak J Ophthalmol 2010, Vol. 26 No. 4 
 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . .  
See end of article for 
authors affiliations 
 
…..……………………….. 
 
Correspondence to: 
Section of Ophthalmology 
Department of Surgery 
Aga Khan University, Karachi  
 
Received for publication 
June’ 2010 
…..……………………….. 

 
 
 
 
 
 
 
 
 
 
 
 

 
akayasu disease is a rare large and medium 
vessel arteritis. It was reported by Dr Mikito 
Takayasu in 1908. It is more common in Asia 

especially in Japan where about 150 cases are reported 
per year1. The disease is reported all over the world 
with an incidence of 2.6 per million / year. The disease 
is more common among females. The ophthalmic 
vascular changes of Takayasu arteritis are described in 
the literature2-8 , and are related to hypoxic changes 
with involvement of the carotids and retinal artery 
stenosis. We report a rare atypical presentation of 
ocular Takayasu disease in a male patient which was 
successfully managed. 
 
CASE REPORT 
A 28-year-old male with known Takayasu disease 
presented to our eye clinic with a 6-month history of 
progressively worsening blurred vision in the left eye. 
On eye examination, his distant vision was 20/40 OD 
and 20/50 OS (uncorrected), corrected vision was 
20/20 OD (-1 DS) and 20/25 0S (-1 DS). Anterior 
segments of both eyes were normal. The right eye 
posterior segment was normal while the left eye 

posterior segment showed macular edema. Fundus 
fluorescence angiography revealed central serous 
retinopathy (Fig 1 and 2). He responded well to 
intravitreal Ranibizumab and Argon Laser (Fig 3 and 
4) with a vision returning to 20/25 unaided over a 9 
month period. 
 
DISCUSSION 
Takayasu disease rarely affects males as it is more 
common in young females. In addition, Takayasu 
retinopathy has various modes of presentation which 
are mainly caused by hypoxia resulting in 
microanuersyms, ischemia, optic neuropathy or 
secondary to hypertensive changes. Our case showed 
none of these changes instead the patient presented 
with a normal retinal vasculature with macular edema 
resulting from central serous retinopathy (CSR) which 
responded to the standard treatment. Causes of CSR 
are not well-established yet. However it is thought to 
be due to retinal pigment epithelial insult, or leakage 
from choriocapillaries. Also neurosensory detachment 
are known to occur in patients on long term cortico-
steroids following organ transplants. The relationship 

T 



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between Takayasu disease and CSR is not established 
in the literature and in our case, this presentation 
could be related to long term corticosteroids or may be 
associated or unassociated to the Takayasu disease. 
 
Author’s affiliation 
Sharmeen Akram 
Section of Ophthalmology 
Department of Surgery 
Aga Khan University, Karachi  
Azam Ali 
 Section of Ophthalmology 
Department of Surgery 
Aga Khan University 
Karachi  
Khabir Ahmad 
Section of Ophthalmology 
Department of Surgery 
Aga Khan University 
Karachi  

REFERENCE 
1. Koide K. Takayasu arteritis in Japan. Heart and Vessels. 1992; 

7: 48-54. 
2. Demir MN, Hazirolan D, Altiparmak UE, et al. Takayasu's 

disease and secondary ocular ischemic syndrome. J Pediatr 
Ophthalmol Strabismus. 2010; 47: 54-7. 

3. Koz OG, Ates A, Numan Alp M, et al. Bilateral ocular 
ischemic syndrome as an initial manifestation of Takayasu's 
arteritis associated with carotid steal syndrome. Rheumatol Int. 
2007; 27: 299-302. 

4. Kaliaperumal S, Gupta A, Sengupta S, et al. Unilateral 
hemorrhagic keratouveitis as the initial presentation of 
Takayasu's arteritis. Indian J Ophthalmol. 2007; 55: 397-8. 

5. Vedantham V, Ratnagiri PK, Ramasamy K. Hypotensive 
retinopathy in Takayasu's arteritis. Ophthalmic Surg Lasers 
Imaging. 2005; 36: 240-4. 

6. Kaushik S, Gupta A, Gupta V, et al. Retinal arterial occlusion 
in Takayasu's arteritis. Indian J Ophthalmol. 2005; 53: 194-6. 

7. Rodriguez-Hurtado FJ, Sabio JM, et al. Ocular involvement in 
Takayasu’s arteritis: response to cyclophosphamide therapy. 
Eur J Med Res. 2002; 7: 128-30. 

8. Karam EZ, Muci-Mendoza R, Hedges TR. 3rd. Retinal 
findings in Takayasu's arteritis. Acta Ophthalmol Scand. 1999; 
77: 209-13.