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

Abstract

Aims: To determine if patients with giant cell arteritis (GCA) treated with corticosteroids develop delayed visual loss or drug related ocular complications.

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 physicians, often outside the study, with the daily dose reduced to the equivalent of 30-40 mg of prednisone within 5 weeks. Subsequently, treatment guidelines suggested that the dose be reduced as tolerated or the patient was withdrawn from steroids in a period not less than 6 months.

Results: At presentation, of the 22 patients enrolled, seven patients had nine eyes with ischaemic injury. Four eyes had improved visual acuity by two lines or more within 1 month of starting corticosteroids. No patients developed 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, there were no significant cataractous or glaucomatous changes. At 2 months, there was no difference in systemic complications between patients who received conventional dose (60-80 mg per day) or very high doses (200-1000 mg per day) of corticosteroids at the start or early in the course.

Conclusions: Patients with GCA related visual loss can improve with treatment. Corticosteroids with starting doses of 60-1000 mg per day, with reduction 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 visual loss. There were no significant drug related ophthalmic complications.

Figure 1

Changes in visual acuity expressed by eye as a decimal value. Recall three eyes in two patients had better pre-entry acuity which deteriorated within 5 days on oral prednisone.

Figure 2

Changes in visual acuity at 1 year. Positive numbers indicate improvement and negative numbers, worsening. Frequency is expressed as number of eyes.

Figure 3

Change in contrast at 1 year from baseline expressed in log units ×10⁻¹. Positive numbers indicate improvement and negative numbers, worsening. Frequency is expressed as number of eyes.