Treatment of Optic Neuropathy With Megadose Corticosteroids-Reply

In Reply.  —We fully agree with Dr Spoor's letter that intravenous pulse methylprednisolone may be highly useful in the treatment of autoimmune disorders. This form of therapy has been used successfully in uncontrolled studies of patients with SLE, particularly lupus nephritis, and other autoimmune diseases. Indeed, patient 4 in our study was treated with this form of therapy, with a prompt response in her clinical picture.We add two notes of caution, however. The first is that the effect of pulse corticosteroids may be short lived and that subsequent daily corticosteroid or immunosuppressive treatment may be required. This is particularly true for chronic diseases such as SLE. The second is that complications of this treatment have been observed in as high as 56% of patients so treated.¹ The most serious of these have been life-threatening dissemination of occult infection,¹ cardiac arrest,² and sudden death.³ These