Visual performance in giant cell arteritis (temporal arteritis) after 1 year of therapy

Aims-To determine if patients with giant cell arteritis (GCA) treated with corticosteroids develop delayed visual loss or drug related ocular complica tions. Methods-In a multicentre prospective study patients with GCA (using precise diagnostic criteria) had ophthalmic evaluations at predetermined intervals up to 1 year. The dose of corticosteroid was determined by treating physic ians, often outside the study, with the daily dose reduced to the equivalen t of 30-40 mg of prednisone within 5 weeks. Subsequently, treatment guideli nes suggested that the dose be reduced as tolerated or the patient was with drawn from steroids in a period not less than 6 months. Results-At presentation, of the 22 patients enrolled, seven patients had ni ne eyes with ischaemic injury. Four eyes had improved visual acuity by two lines or more within 1 month of starting corticosteroids. No patients devel oped late visual loss as the steroid dose was reduced. At 1 year the visual acuity, contrast sensitivity, colour vision, and threshold perimetry were not significantly different from the 4-5 week determinations. At 1 year, th ere were no significant cataractous or glaucomatous changes. At 2 months, t here was no difference in systemic complications between patients who recei ved conventional dose (60-80 mg per day) or very high doses (200-1000 mg pe r day) of corticosteroids at the start or early in the course. Conclusions-Patients with GCA related visual loss can improve with treatmen t. Corticosteroids with starting doses of 60-1000 mg per day, with reductio n to daily doses of 40-50 mg per day given for 4-6 weeks, and gradual dose reduction thereafter, as clinically permitted, did not result in delayed vi sual loss. There were no significant drug related ophthalmic complications.