Temporal Arteritis-Reversal of Blindness Using Antlcoagulation and Steroids

摘要

The aim of the report is to document two cases of biopsy-proven temporal arteritis, resulting in major visual loss that recovered almost completely after treatment with intravenous methylprednisolone and intravenous heparin infusion. An 80-year-old Caucasian lady presented with vision of perception of light (PL) due to a central retinal artery occlusion. Following systematic treatment with anterior chamber paracentesis, intravenous heparin, and intravenous steroids, vision improved to 6/5. A definitive diagnosis was made following temporal artery biopsy. A 77-year-old Caucasian lady presented with treated polymyalgia rheumatica, which on further history and examination was confirmed to be temporal arteritis. Prompt treatment of her arteritic anterior ischaemic optic neuropathy with intravenous methylprednisolone and intravenous heparin infusion resulted in improvement of visual acuity from 6/12 to 6/5 with a sustained improvement in visual fields and in the funduscopically visible optic nerve ischaemic changes. The authors conclude that near-complete resolution of major visual loss in these two patients with biopsy-proven temporal arteritis suggests that the appropriate use of a therapeutic intravenous methylprednisolone and heparin protocol could represent a way forward in the management of this potentially blinding disease. This would need to be confirmed in large prospective, randomised controlled studies.