Swollen optic disc and macular area in arteritic ischemic optic neuropathy.
Fluorescein angiogram of the same patient as in Fig. 12.1, showing choroidal hypoperfusion.
If the disease is not found in adequate biopsy specimens, steroids are usually
ceased – unless clinical suspicion is high and a response to treatment has been
observed. Notably, unnecessary administration of corticosteroids may cause substantial morbidity.
Surgery Temporal artery biopsy is usually performed within a few days of presentation, because the histological features of GCA may recede after more than a week of corticosteroid treatment. Biopsy is particularly important when
steroids are relatively contraindicated, as in patients with diabetes. A negative biopsy result does not completely exclude the diagnosis of GCA.
Ocular tests and imaging investigations
Ocular pneumoplethysmography, looking for reduced ocular blood flow, may be considered.
Review The steroid dose is tapered slowly, with monitoring of symptoms and ESR. Treatment is continued for at least 6 months.