Progressive visual loss from giant cell arteritis despite high dose intravenous methylprednisolone

Background: 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 high-dose intravenous methylprednisolone (IVMP) has been reported to enhance visual recovery, Methods: The authors reviewed patient charts from two university-based neuroophthalmology services and reviewed all previously reported cases of GCA treated with IVMP. Results: 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, Conclusions: 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.