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September 1988

Progressive Anterior Ischemic Optic Neuropathy due to Giant Cell Arteritis Despite High-Dose Intravenous Corticosteroids

Author Affiliations

New Hyde Park, NY

Arch Ophthalmol. 1988;106(9):1167. doi:10.1001/archopht.1988.01060140327015

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To the Editor.  —Bilateral loss of vision from anterior ischemic optic neuropathy due to untreated giant cell arteritis may occur simultaneously or the second eye may become involved as early as several days later. Indeed, Egge et al1 reported involvement of the fellow eye at one to five days in seven of 14 patients. Although oral corticosteroid therapy (for example, prednisone, 80 to 100 mg/d) is commonly used after anterior ischemic optic neuropathy in one eye in this setting, occasional cases have been reported in which severe visual loss occurs in the fellow eye despite this mode of therapy.2 Several investigators,3 therefore, have promoted the use of high-dose intravenous corticosteroids at the onset of unilateral involvement. The rationale for this is twofold: to best achieve a protective effect on the fellow eye in the early vulnerable period and to recover vision in the initially involved eye.4

Egge K, Mitbo A, Westby R:  Arteritis temporalis . Acta Ophthalmologica 1966;44:49-56.Article
Cohen DN:  Temporal arteritis: Improvement in visual prognosis and management with repeat biopsies . Ophthalmology 1975;77:74-85.
Rosenfeld SI, Kosmorsky GS, Klingele TG, et al:  Treatment of temporal arteritis with ocular involvement . Am J Med 1986;80:143-145.Article
Model DG:  Reversal of blindness in temporal arteritis with methylprednisolone . Lancet 1978;1:340.Article