Detection of early ocular circulatory changes in Takayasu arteritis using laser speckle flowgraphy

To describe a case of early-stage Takayasu arteritis (TA) in which ocular hypoperfusion was detected using laser speckle flowgraphy (LSFG) and subsequently monitored during systemic corticosteroid therapy. A 48-year-old man presented with transient bilateral blurred vision during exercise. The initial ophthalmic examination revealed structural abnormalities on optical coherence tomography, including thinning of the retinal ganglion cell-inner plexiform layer. LSFG showed reduced blood flow in the optic nerve head and choroidal regions, while optical coherence tomography angiography (OCTA) demonstrated decreased retinal vascular density. He was diagnosed with TA based on systemic inflammation, hypotension, and positron emission tomography/computed tomography findings of large-vessel involvement. High-dose oral corticosteroid therapy normalized blood pressure and inflammatory markers, accompanied by a rapid improvement in LSFG-derived ocular perfusion and increased retinal vascular density on OCTA. This case illustrates that ocular hypoperfusion may be present in early-stage TA even in the absence of advanced fundus features of Takayasu retinopathy. LSFG can detect dynamic and reversible perfusion abnormalities, and when combined with OCTA, provides a sensitive, noninvasive approach for identifying early ocular involvement and monitoring treatment response in TA.