PROGRESSIVE VISUAL-LOSS FROM GIANT-CELL ARTERITIS DESPITE HIGH-DOSE INTRAVENOUS METHYLPREDNISOLONE

Background: Giant cell arteritis (GCA) often presents with devastating visual loss in the elderly, yet the ideal treatment is unknown. The d isease most often has been treated with oral prednisone, although rece ntly the use of high-dose intravenous methylprednisolone (IVMP) has be en reported to enhance visual recovery, Methods: The authors reviewed patient charts from two university-based neuroophthalmology services a nd reviewed all previously reported cases of GCA treated with IVMP. Re sults: Four patients with GCA exhibited severe, progressive visual los s after at least 48 hours of high-dose IVMP, A fifth patient had furth er visual loss in one eye and improvement in the other eye after 24 ho urs of IVMP. In previous reports of IVMP treatment in GCA, four patien ts lost vision and 14 patients recovered vision, The authors review th e details of these reports, Conclusions: The results of IVMP treatment of patients with visual loss from GCA are similar to the results of t reatment with oral corticosteroids, with IVMP treatment being more cos tly and having a small risk of sudden death. The optimal dosage and ro ute of corticosteroid treatment for GCA with visual loss remain elusiv e and warrant a treatment trial.