Poor Prognosis of Visual Outcome after Visual Loss from Giant Cell Arteritis
Received 6 November 2004; accepted 10 January 2005. published online 09 May 2005.
Objective
To evaluate the incidence and extent of visual recovery in patients with giant cell arteritis (GCA) treated with high doses of systemic corticosteroids.
Design
Multicenter prospective case series.
Participants
Thirty-four consecutive patients with biopsy-proven GCA and visual loss seen at either Wills Eye Hospital in Philadelphia or Auckland Hospital in New Zealand from 2001 to 2004 were evaluated prospectively.
Methods
All patients underwent a complete neuro-ophthalmic evaluation that included Snellen visual acuity, pseudoisochromatic Ishihara color plates, visual fields, intraocular pressure, slit-lamp examination, and binocular ophthalmoscopy. Formal visual field testing was performed on all patients who were capable of completing the test. All patients were treated with a standard protocol of 1 g of IV methylprednisolone daily for 3 days followed by oral prednisone 60 or 80 mg (depending on patient weight). Patients were evaluated initially at 2-week intervals (14–19 days) and then monthly (4–5 weeks), with subsequent dosages of prednisone modified based on erythrocyte sedimentation rate, C-reactive protein, and patient symptoms. At each visit, patients underwent a repeat complete neuro-ophthalmic evaluation.
Main Outcome Measures
Alterations in visual acuity, visual field, and color vision.
Results
Patients with visual loss from GCA had a mean visual acuity of 20/400. Visual deterioration occurred in 27% of eyes within the first week despite high-dose IV corticosteroids. Fifteen percent of eyes showed an improvement of visual acuity within the first month, but only 5% have corresponding improvement in visual field.
Conclusions
Visual recovery is uncommon in patients who lose vision from GCA. Recovery in visual acuity is not associated with visual field or color vision improvement in this series. Visual deterioration occurs in approximately 27% of eyes despite high-dose IV methylprednisolone. The greatest risk of visual deterioration is in the first 6 days.
1Department of Ophthalmology, University of Auckland, Auckland, New Zealand.
2Neuro-ophthalmology Service, Wills Eye Hospital, Thomas Jefferson Medical School, Philadelphia, Pennsylvania.
3Department of Medicine, University of Auckland, Auckland, New Zealand.
Reprint requests to Helen Danesh-Meyer, FRANZCO, Department of Ophthalmology, University of Auckland, Private Bag 92019, Auckland, New Zealand.
ABSTRACT