ABSTRACT
BACKGROUND: Steroids are the treatment of choice for giant cell arteritis but bear the risk of serious side effects. PATIENTS AND METHODS: We carried out a retrospective study on 34 patients with documented giant cell arteritis (24 with ocular involvement) by means of a questionnaire sent to the treating physicians. RESULTS: After a mean follow-up of 48 months, side effects occurred in 90 % of the patients. The most frequent were weight gain (> 50 %) and osteoporosis (> 40 %, F >> M). Side effects were more common in patients with ocular involvement and in women. Severe complications were significantly more frequent in patients with ocular involvement. CONCLUSIONS: Side effects are the rule and not the exception in the treatment of giant cell arteritis. They can affect quality of life. Physicians should bear them in mind as many are preventable and/or treatable.
Subject(s)
Adrenal Cortex Hormones/adverse effects , Adrenal Cortex Hormones/therapeutic use , Giant Cell Arteritis/complications , Giant Cell Arteritis/drug therapy , Optic Neuropathy, Ischemic/etiology , Optic Neuropathy, Ischemic/prevention & control , Risk Assessment/methods , Female , Humans , Male , Retrospective Studies , Risk Factors , Treatment OutcomeABSTRACT
PURPOSE: To prospectively assess the magnification requirement after repeat photodynamic therapy (PDT) with verteporfin in patients with predominantly classic subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration (AMD). METHODS: A total of 103 patients were treated for the first time with PDT between November 1999 and September 2002. These patients were followed up at 3-month intervals for a minimum of 12 months. In addition to the usual investigations undertaken during PDT therapy, the magnification requirement was determined, under standardized conditions, using the SZB test developed by the Swiss Central Association for Blindness. RESULTS: A stable lesion with a stable magnification requirement was achieved in 86 (83.5%) patients; these patients were followed up for 24.8 months (range 12 to 36 months). At the time of the last follow-up examination, the magnification requirement compared with baseline was < 3 log units higher in 46 patients (53.5%) and > or = 3 log units higher in the remaining 40 patients (46.5%). Seventy-four (86%) of these 86 patients had a magnification requirement of < or = 8x. Stability was not achieved in 17 (16.5%) patients; up to the last examination these patients had been followed up for 12 to 30 months (mean 20.8). At the time of the most recent examination, 7 (41.2%) patients had a higher magnification requirement of < 3 log units while 10 (58.8%) had changed by > or = 3 log units. Sixteen patients (94%) had a magnification requirement of < or = 8x. CONCLUSIONS: PDT with verteporfin helps achieve stability without severe impairment in reading ability in most patients with predominantly classic subfoveal CNV due to AMD.
Subject(s)
Choroidal Neovascularization/drug therapy , Choroidal Neovascularization/physiopathology , Eyeglasses , Macular Degeneration/complications , Photochemotherapy , Photosensitizing Agents/therapeutic use , Porphyrins/therapeutic use , Visual Acuity/physiology , Aged , Choroidal Neovascularization/etiology , Follow-Up Studies , Humans , Male , Postoperative Period , Prospective Studies , Reading , Verteporfin , Vision TestsABSTRACT
BACKGROUND: A prospective uncontrolled follow-up of changes in reading ability after PDT with Verteporfin in patients with predominantly classic subfoveal choroidal neovascularization (CNV) due to AMD or high myopia was carried out. PATIENTS AND METHODS: A follow-up time of at least 6 months is documented for 48 patients with AMD and for 22 patients with high myopia. In addition to the usual clinical parameters the need for magnification was measured using standardized reading charts provided by the SZB.A need for magnification higher than 3.2-fold was defined as a severe loss in reading ability.PDT's were repeated every 3 months according to the usual guidelines. RESULTS: Before treatment, the mean reading acuity for patients with AMD was between 20/200 and 20/100. The average need for magnification was between 2.5-fold and 3.2-fold.Reading acuity, need for magnification and the percentage of patients with a need for magnification of 3.2-fold or less remained stable over a 6-12 months follow-up period. High myopic patients initially had a mean reading acuity of 20/200 and a need for magnification of 2.5-fold. After 9 months follow-up, reading acuity showed a mean improvement from 0.2 up to 0.3 ( p<0.05). There was also a trend towards improvement in the need for magnification and the percentage of patients with a need for magnification of 3.2-fold or less improved significantly from 68% to 78% ( p<0.05). CONCLUSION: Reading ability could be stabilized with PDT for predominantly classic subfoveal CNV in patients with high myopia or AMD for at least 9-12 months. The risk of developing a severe loss in reading ability (need for magnification >3.2-fold) was significantly reduced in high myopia and was stable over time in AMD.
Subject(s)
Hematoporphyrin Photoradiation , Macular Degeneration/drug therapy , Myopia/drug therapy , Reading , Aged , Aged, 80 and over , Choroidal Neovascularization/drug therapy , Eyeglasses , Female , Fluorescein Angiography , Follow-Up Studies , Humans , Male , Middle Aged , Porphyrins/administration & dosage , Verteporfin , Visual Acuity/drug effectsABSTRACT
We report a patient with systemic large cell non-Hodgkin lymphoma in remission who presented with the rare combination of optic neuropathy and central retinal artery occlusion. Another unusual feature of this case is the lack of enhancement in the affected region on magnetic resonance imaging only hours after the first dose of steroids. Despite prompt treatment with steroids and radiotherapy, lymphomatous infiltration of the meninges developed 2 months later and was ultimately fatal.
Subject(s)
Brain Neoplasms/complications , Eye Neoplasms/complications , Lymphoma, Large B-Cell, Diffuse/complications , Optic Nerve Diseases/etiology , Retinal Artery Occlusion/etiology , Aged , Blindness/diagnosis , Blindness/etiology , Brain Neoplasms/diagnosis , Eye Neoplasms/diagnosis , Fatal Outcome , Female , Fluorescein Angiography , Humans , Lymphoma, Large B-Cell, Diffuse/diagnosis , Magnetic Resonance Imaging , Optic Nerve Diseases/diagnosis , Papilledema/diagnosis , Papilledema/etiology , Retinal Artery Occlusion/diagnosisABSTRACT
Dysthyroid orbitopathy is an autoimmune disorder usually occurring in the setting of Graves' disease. The pathogenesis is incompletely understood but involves autoantibodies against orbital tissue. The clinical course is highly variable. Signs range from mild to severe soft tissue swelling, lid retraction, proptosis and extraocular muscle involvement with diplopia, to corneal damage and optic nerve compression with irreversible visual loss. After a few years, the phase of active inflammation is usually followed by a chronic stage with or without residual damage through fibrosis. Each stage requires a carefully adjusted therapy and optimal cooperation between the general practitioner, the ophthalmologist and other specialists involved. Therapeutic options range from topical lubricants to systemic steroids, radiation and surgery.
