VISUAL IMPROVEMENT OR DETERIORATION IN GCA WITH HIGH-DOSE CORTICOSTEROID THERAPY

Visual improvement: A review of the literature reveals many reports claiming visual improvement with systemic corticosteroid therapy. Some claim complete recovery or "dramatic improvement" of visual acuity in every eye, others in almost half and still others only rarely. In our study⁴ of 114 eyes with visual loss due to GCA and treated with high-dose steroid therapy, only 4% had a variable amount of improved vision, none completely. The data also suggested that there is a better (p=0.065) chance of visual improvement with early diagnosis and immediate start of steroid therapy. We did not find a significant difference in the visual outcome between those treated with mega-dose intravenous steroid therapy versus high-dose oral steroid therapy.

Visual deterioration: Our study⁵ of 144 GCA patients (271 eyes) showed that although a few eyes (4% of the eyes or 6% of the patients) can develop visual deterioration while on high doses of steroid therapy, early, adequate steroid therapy is effective in preventing further visual loss in the vast majority. When further visual deterioration occurred in spite of high doses of systemic corticosteroids, it almost invariably started within 5 days after initiation of high dose steroid therapy. Thus, early and aggressive steroid therapy can reduce the risk of further visual loss. There was no evidence that intravenous mega-dose steroid therapy was more effective than high-dose oral therapy in preventing visual deterioration.

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