Treatment of temporal arteritis with ocular involvement

Area of Science:

• Ophthalmology
• Rheumatology
• Neurology

Background:

• Giant cell arteritis (GCA), also known as temporal arteritis, is a systemic vasculitis that can lead to ischemic complications.
• Ocular involvement in GCA, particularly arteritic anterior ischemic optic neuropathy (AAION), is a leading cause of irreversible vision loss in the elderly.
• Standard treatment with oral corticosteroids may not always prevent progressive visual decline in affected patients.

Observation:

• A 78-year-old woman with temporal arteritis experienced catastrophic vision loss in one eye and progressive visual decline in the second eye despite adequate oral corticosteroid therapy.
• Retinal ischemia in the second eye persisted despite normalization of the Westergren erythrocyte sedimentation rate, indicating treatment inadequacy.

Findings:

• Pulsed intravenous methylprednisolone (1,000 mg every 12 hours) led to significant visual recovery in the affected eye.
• This intensive treatment strategy halted the progression of retinal ischemia and preserved vision in the previously uninvolved eye.

Implications:

• Brief hospitalization for intravenous methylprednisolone administration may be a crucial intervention for patients with arteritic ischemic optic neuropathy.
• This approach offers a significant opportunity for visual recovery in the affected eye and provides essential protection for the contralateral eye.
• Intravenous methylprednisolone should be considered in managing sight-threatening GCA, especially in cases of progressive visual loss despite conventional oral therapy.