Poor Prognosis of Visual Outcome after Visual Loss from Giant Cell Arteritis

Aortitis

“…100,104 Patients with visual symptoms related to GCA generally are admitted to the hospital for intravenous glucocorticoid therapy, followed by oral therapy, although the likelihood of permanent visual deficits remains high, even among those aggressively treated. 105,106 Patients with severe symptoms related to aortitis such as acute aortic insufficiency or coronary artery involvement should similarly be treated in hospital with initial intravenous therapy. Several studies have investigated potential steroid-sparing regimens for both GCA and Takayasu arteritis because of the potential need for long-term immunosuppressive therapy.…”

Diagnosis and Treatment of Giant Cell Arteritis (Temporal Arteritis) – Past, Current and Future Aspects

“…Several cases of Charles Bonnet syndrome have been reported (43,44). Visual manifestations usually present early in the disease course, and are rarely seen after 2-3 years of disease (25,45,46,47). In one study (25) visual impairment occurred at onset in only 2.7% as opposed to 17.9% at the time of diagnosis.…”

“…In rare cases, transient visual disturbances preceding permanent visual loss may alternate between the two eyes (42). The risk of developing visual disturbances has been associated with low disease activity (37,58,59), high disease activity (37,45,60), anemia (61), older age (37,38), disc swelling (37), and a history of hypertension (62). In some studies, the best predictors for the development of severe cranial ischemic events included the absence of high CRP and ESR levels at diagnosis, absence of systemic manifestations such as fever and weight loss, and a past history of ischemic heart disease (58,62).…”

“…In patients with visual disturbances, further deterioration of vision usually takes place in the first 5-6 days of steroid initiation (46). Recurrences of visual loss most often occur between 3 and 36 months after the initial visual loss (45). Relapses are most commonly accompanied by increased acute phase parameters.…”

Neuro-ophthalmic complications in giant cell arteritis

“…Patients with visual loss at presentation are unlikely to recover vision [ 11 ]. This tends to occur early, before or within the fi rst week of treatment with steroids [ 5•• , 11 , 12 ].…”