Search

Objective: To evaluate the incidence and extent of visual recovery in patients with giant cell arteritis (GCA) treated with high doses of systemic corticosteroids. Design: Multicenter prospective case series. Participants: Thirty-four consecutive patients with biopsy-proven GCA and visual loss seen at either Wills Eye Hospital in Philadelphia or Auckland Hospital in New Zealand from 2001 to 2004 were evaluated prospectively. Methods: All patients underwent a complete neuro-ophthalmic evaluation that included Snellen visual acuity, pseudoisochromatic Ishihara color plates, visual fields, intraocular pressure, slit-lamp examination, and binocular ophthalmoscopy. Formal visual field testing was performed on all patients who were capable of completing the test. All patients were treated with a standard protocol of 1 g of IV methylprednisolone daily for 3 days followed by oral prednisone 60 or 80 mg (depending on patient weight). Patients were evaluated initially at 2-week intervals (14–19 days) and then monthly (4–5 weeks), with subsequent dosages of prednisone modified based on erythrocyte sedimentation rate, C-reactive protein, and patient symptoms. At each visit, patients underwent a repeat complete neuro-ophthalmic evaluation. Main Outcome Measures: Alterations in visual acuity, visual field, and color vision. Results: Patients with visual loss from GCA had a mean visual acuity of 20/400. Visual deterioration occurred in 27% of eyes within the first week despite high-dose IV corticosteroids. Fifteen percent of eyes showed an improvement of visual acuity within the first month, but only 5% have corresponding improvement in visual field. Conclusions: Visual recovery is uncommon in patients who lose vision from GCA. Recovery in visual acuity is not associated with visual field or color vision improvement in this series. Visual deterioration occurs in approximately 27% of eyes despite high-dose IV methylprednisolone. The greatest risk of visual deterioration is in the first 6 days. [Copyright &y& Elsevier]

Objective: Quantitative data are not available regarding the morphological appearance of optic nerve morphology after arteritic anterior ischemic optic neuropathy (AAION) and nonarteritic anterior ischemic optic neuropathy (NAION). The purpose of this study is to evaluate the appearance of the optic nerve head in patients after AAION and NAION with the Heidelberg Retina Tomograph (HRT). Design: Prospective comparative observational study. Participants: Thirty-eight patients with either unilateral AAION (15) or NAION (23). Methods: Heidelberg Retina Tomograph images were taken of both affected and unaffected eyes. The quantitative changes in the optic nerve head were morphologically evaluated and compared with those of the normal contralateral eyes. Main outcome measures: Heidelberg Retina Tomograph parameters were analyzed using the uninvolved contralateral eye as a control. Results: The ratio between cup area and disc area was 42% larger in the affected eyes in the NAION group than in the fellow eyes (P = 0.03, t test). In the AAION patients, the ratio between cup area and disc area was 116% larger in involved eyes than in their fellow eyes (P = 0.0003, t test). In addition, in the AAION group, relative to their fellow eyes, the rim area was 27% smaller (P = 0.0006), cup volume was 160% larger (P = 0.021, t test), mean cup depth was 29% larger, cup shape measure differed by 41% (suggesting more excavation), and mean retinal nerve fiber layer thickness was 30% less. Relative to the fellow eyes in the NAION group, the rim area was 6% smaller (P = 0.13, Student’s t test), and the cup shape measure was 13% different, although these were not statistically significant. When the uninvolved eyes of the NAION and AAION groups were compared directly, there was no statistical difference between any of the HRT parameters, except mean cup depth (0.09 vs. 0.14 mm, respectively; P = 0.02). Conclusions: This study is the first to demonstrate quantitatively an enlargement and excavation of the optic cup after an event of AAION, but not NAION. The eyes affected with AAION showed significant excavation and enlargement of the optic cup when compared with contralateral uninvolved eyes. All HRT-generated parameters showed changes consistent with increased enlargement and excavation of AAION-involved eyes. These changes were not observed in eyes that experienced an event of NAION. [Copyright &y& Elsevier]