Bilateral amaurosis in 11 patients with giant cell arteritis confirmed by arterial biopsy

Abstract

Even in the times of corticosteroids giant cell arteritis may lead to complete bilateral blindness. To assess the frequency of complete irreversible blindness in giant cell arteritis. Among all 218 patients with the diagnosis of giant cell arteritis confirmed by arterial biopsy between 1980 and 2000, clinical data of patients with bilateral amaurosis were further investigated. The main interest was focussed on the kind of ocular manifestation, the interval between first symptoms and therapy and the interval between involvement of the first and second eye. In 11 patients (9 women, 2 men, mean age: 79 years) giant cell arteritis led to complete bilateral blindness. Morphological ocular changes were anterior ischemic optic neuropathy (15 eyes), optic atrophy (4 eyes), posterior ischemic optic neuropathy (2 eyes), and central artery occlusion (1 eye). The median interval between involvement of the first eye and initiation of therapy was 4 days (1/2 day to 8 weeks). The median interval between visual loss in the first and second eye measured 4 days (simultaneously to 30 days). In 2 patients visual loss occurred 1 and 2 days after initiation of treatment (500 mg methylprednisolone/daily), respectively. Treatment with corticosteroids (100 - 1000 mg) did not result in visual improvement in any patient. Complete bilateral blindness occurred in 5 % of patients with giant cell arteritis, up to 2 days after initiation of treatment with corticosteroids. This number can only be further reduced by immediate therapy after clinical suspicion of giant cell arteritis.