Cornblath W T, Eggenberger E R
University of Michigan, Department of Ophthalmology, Ann Arbor, USA.
Ophthalmology. 1997 May;104(5):854-8. doi: 10.1016/s0161-6420(97)30222-x.
Giant cell arteritis (GCA) often presents with devastating visual loss in the elderly, yet the ideal treatment is unknown. The disease most often has been treated with oral prednisone, although recently the use of the high-dose intravenous methylprednisolone (IVMP) has been reported to enhance visual recovery.
The authors reviewed patient charts from two university-based neuroophthalmology services and reviewed all previously reported cases of GCA treated with IVMP.
Four patients with GCA exhibited severe, progressive visual loss after at least 48 hours of high-dose IVMP. A fifth patient had further visual loss in one eye and improvement in the other eye after 24 hours of IVMP. In previous reports of IVMP treatment in GCA, four patients lost vision and 14 patients recovered vision. The authors review the details of these reports.
The results of IVMP treatment of patients with visual loss from GCA are similar to the results of treatment with oral corticosteroids, with IVMP treatment being more costly and having a small risk of sudden death. The optimal dosage and route of corticosteroid treatment for GCA with visual loss remain elusive and warrant a treatment trial.
巨细胞动脉炎（GCA）在老年人中常导致严重的视力丧失，但其理想治疗方法尚不清楚。该病最常采用口服泼尼松治疗，不过最近有报道称，使用大剂量静脉注射甲基泼尼松龙（IVMP）可促进视力恢复。
作者回顾了两所大学神经眼科服务机构的患者病历，并查阅了所有先前报道的接受IVMP治疗的GCA病例。
4例GCA患者在接受至少48小时的大剂量IVMP治疗后出现严重的进行性视力丧失。第5例患者在接受24小时IVMP治疗后，一只眼睛视力进一步下降，另一只眼睛视力改善。在先前关于GCA的IVMP治疗报告中，4例患者视力丧失，14例患者视力恢复。作者回顾了这些报告的详细情况。
IVMP治疗GCA导致视力丧失患者的结果与口服糖皮质激素治疗的结果相似，IVMP治疗成本更高且有小的猝死风险。对于伴有视力丧失的GCA，糖皮质激素治疗的最佳剂量和途径仍不明确，值得进行治疗试验。
