Liu G T, Glaser J S, Schatz N J, Smith J L
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine.
Ophthalmology. 1994 Nov;101(11):1779-85. doi: 10.1016/s0161-6420(94)31102-x.
To characterize visual morbidity in giant cell arteritis and to assess prognosis with respect to treatment.
Record review of 185 patients with coded diagnosis of giant cell (cranial) arteritis examined at the Bascom Palmer Eye Institute from January 1, 1980, to January 31, 1993.
Forty-five patients with biopsy-proven giant cell arteritis had visual symptoms, and 41 individuals (63 eyes) lost vision. The visual loss was unilateral in 19 patients (46%), sequential in 15 (37%), and simultaneous in 7 (17%). Anterior ischemic optic neuropathy developed in 88% of eyes, visual acuity was 20/200 or worse in 70%, 21% had no light perception, and the majority of field defects in testable eyes, aside from central scotomas associated with loss, showed altitudinal or arcuate patterns. Six patients lost vision during corticosteroid therapy for systemic symptoms of giant cell arteritis, whereas in 39 patients visual symptoms prompted steroid treatment. For visual symptoms, 25 patients received intravenous methylprednisolone, whereas 20 received oral prednisone alone. In the 41 patients with visual loss, vision was unchanged in 20 (49%), it worsened in 7 (17%), and it improved in 14 (34%). Subsequent fellow eye involvement was observed only with oral therapy, and a greater percentage of patients (9/23 [39%] versus 5/18 [28%]) improved after intravenous treatment.
In the authors' series, patients with visual loss due to giant cell arteritis had a 34% chance for some improvement in visual function after corticosteroid treatment. Intravenous therapy may diminish the likelihood of fellow eye involvement and was associated with a slightly better prognosis for visual improvement.
描述巨细胞动脉炎的视觉病变特征，并评估其治疗预后。
回顾性分析1980年1月1日至1993年1月31日在巴斯科姆·帕尔默眼科研究所接受检查的185例编码诊断为巨细胞（颅）动脉炎患者的病历。
45例经活检证实的巨细胞动脉炎患者有视觉症状，41例（63只眼）视力丧失。19例（46%）患者视力丧失为单侧性，15例（37%）为相继性，7例（17%）为同时性。88%的患眼发生前部缺血性视神经病变，70%的患眼视力为20/200或更差，21%的患眼无光感，除与视力丧失相关的中心暗点外，可检测眼的大多数视野缺损表现为象限性或弓形。6例患者在因巨细胞动脉炎全身症状接受糖皮质激素治疗期间视力丧失，而39例患者因视觉症状接受了激素治疗。对于视觉症状，25例患者接受了静脉注射甲泼尼龙，而20例患者仅接受口服泼尼松。在41例视力丧失的患者中，20例（49%）视力无变化，7例（17%）视力恶化，14例（34%）视力改善。仅在口服治疗时观察到后续对侧眼受累，静脉治疗后改善的患者比例更高（9/23 [39%] 对5/18 [28%]）。
在作者的系列研究中，因巨细胞动脉炎导致视力丧失的患者在接受糖皮质激素治疗后，视觉功能有34%的机会得到一定改善。静脉治疗可能会降低对侧眼受累的可能性，并且与视觉改善的预后稍好相关。
