THE EFFICACY OF SYSTEMIC CORTICOSTEROIDS IN SIGHT-THREATENING RETINALVASCULITIS

This study was undertaken to assess the efficacy of a standard regime of high-dose systemic oral corticosteroids in the management of retina l vasculitis. The study was performed because the single most common r eason for referral to our specialist clinic is the apparent failure of patients to respond to a course of systemic steroids, which in most c ases appeared to be due to an inadequate initial dose. A retrospective study of 29 patients (30 treatment episodes) with sight-threatening r etinal vasculitis managed initially with high-dose systemic steroids w as evaluated 1 year after treatment. Patients included in the study al l started treatment with greater than or equal to 1 mg/kg prednisolone and remained on a high steroid dose (greater than or equal to 40 mg p rednisolone) for at least 5 weeks. No patient was on any other immunos uppressive agent at the start of the study Therapeutic success for thi s regime, as judged by improvement in visual acuity, was 60%, improvin g to 77% with addition of other immunosuppressive agents. Eight patien ts required additional immunosuppressives. Although documented side-ef fects of steroids were common (50% of cases managed on steroids alone) , in only 5 patients were they therapeutically important. Twelve of th e 22 patients managed on high-dose steroids alone were off treatment a t 12 months. There was no correlation at any stage between visual acui ty, activity index or relapses and the final visual outcome at 12 mont hs. Seven cases had a poor visual outcome and the causes for this incl uded relapse in the twelfth month of follow-up, persistent cystoid mac ular oedema and lens opacity. These results suggest that high-dose ora l steroids should be tried in the initial management of such patients before contemplating other more complicated regimes or accepting a poo r visual outcome.