POS0808 CHARACTERISTICS AND PROGNOSIS OF BINOCULAR DIPLOPIA IN PATIENTS WITH GIANT CELL ARTERITIS

Background

Giant cell arteritis (GCA) is a large vessel vasculitis associated with a risk of permanent ophthalmologic complications. Diplopia is an uncommon feature at GCA diagnosis and data about diplopia in GCA are scarce, especially regarding its prognosis.

Objectives

This study was designed to better characterize diplopia in newly diagnosed GCA patients.

Methods

All consecutive patients diagnosed with GCA between January 2015 and April 2021 in a French tertiary ophthalmologic center were retrospectively reviewed. GCA diagnosis relied on 1990 ACR criteria and either a positive temporal artery biopsy or high-definition MRI.

Results

Among 111 patients diagnosed with GCA in our tertiary eye-care center, 80 patients (72%) had visual signs, including 30 patients (27%) with binocular diplopia. Characteristics of patients with diplopia were similar to other GCA patients. Twenty-eight patients (93%) had cephalic symptoms (Headaches n = 25, scalp tenderness n = 14, jaw claudication n = 17) and 7 patients (23%) had associated polymyalgia rheumatica. All patients with diplopia had an elevated C-reactive protein compared with 91% of patients without diplopia (p = 0.06). Large vessel involvement was found in 4 patients (16%) with diplopia. Diplopia was attributed to cranial nerve palsy in 21/24 (88%) patients, especially third (50%) and sixth cranial nerve (48%) palsies. Median duration of diplopia before GCA diagnosis was 10 days (Inter-quartile range [IQR]: 4-19). Eleven patients (37%) were diagnosed with ocular ischemic lesions, including 5 patients (17%) with bilateral visual impairment, resulting in a severe loss of vision in 9 patients and a resolution of binocular diplopia in all these patients due to unilateral or bilateral vision loss. Acute ischemic optic neuropathy (AION) was diagnosed in 11 eyes, central retinal artery occlusion (CRAO) in 4 eyes and paracentral acute middle maculopathy in 2 eyes. Diplopia resolved spontaneously in 6 patients (20%). In the remaining 13 patients, diplopia resolved after the initiation of corticosteroids in 12 patients (92%) with a median delay of 10 days (IQR: 5-24). IV corticosteroids seemed to be associated with a quicker improvement than oral corticosteroids (6 days [IQR 4-28] vs 11 days [IQR 6-13], p = 0.81) but with a similar resolution rate of diplopia at one month (66% vs 78 %, p = 1). Two patients had visual impairment after the initiation of corticosteroids and two patients had diplopia relapse during the course of GCA.

Conclusion

Diplopia is a rare but not exceptional feature at GCA diagnosis and should raise clinician suspicion for GCA when associated with cephalic symptoms and elevated inflammatory biomarkers. We confirmed in this study that patients with diplopia were also at risk of ischemic ocular lesions, particularly AION and CRAO, with a subsequent risk of severe loss of vision. In patients without visual impairment, the prognosis of diplopia is good after initiation of treatment with a complete resolution in most patients at one month but with a potential risk of diplopia recurrence in case of GCA relapse.

Disclosure of Interests

None declared

Pregnancy and newborn outcomes after exposure to bisphosphonates: a case-control study

We analyzed women and newborn outcome after maternal exposure to BPs. BPs have no teratogenic effect on the 36 analyzed pregnancies compared to unexposed controls matched on women underlying diseases (either systemic disease, either "bone" disease) but some outcome differed: neonatal complications rate in systemic diseases and live birth rate in bone diseases).

INTRODUCTION

The effect of bisphosphonates (BPs) during pregnancy remains unclear. We aimed to study pregnancy outcomes in women exposed to BPs during pregnancy.

METHODS

Data for cases and controls were from the French Reference Centre of Teratogenic Agents. Cases were women who received BPs in the 6 weeks before or during a pregnancy and had systemic or bone diseases. We included two respectively matched control groups: women with systemic diseases not exposed to BPs and healthy women not exposed to BPs or any teratogenic agent. Four controls were assigned to each case.

RESULTS

Thirty-six women were exposed to BPs including 5 just before pregnancy and 30 during the first trimester; 23 had systemic diseases (systemic lupus erythematosus, n = 5; rheumatoid arthritis, n = 5; other, n = 13) and 13 had bone diseases. Rate of observed congenital malformations did not differ in women with a systemic or a bone disease compared to their respective controls (respectively 2/23 [8.7%] vs 2/92 [2.2%], p = 0.178 and 0/13 [0%] vs 0/52 [0%], p = 1.00). Among women with systemic diseases, non-specific neonatal complications were more frequent for cases (4/16 [25.0%] vs 4/64 [6.3%], p = 0.027). Among women with bone disorders, the live birth rate was lower for cases than healthy controls (8/10 [80%] vs 50/50 [100%], p = 0.025).

CONCLUSION

We found no major teratogenic effects of BPs, but rates of neonatal complications were increased for women with systemic diseases, as were spontaneous abortions for women with bone diseases likely linked to the severity of the underlying diseases and concomitant medications.