2020 Volume 37 Issue 4 Pages 423-428
We report a case of arteritic anterior ischemic optic neuropathy in a patient who developed contralateral eye involvement during steroid therapy. An 85-year-old woman presented with visual acuity classified as“hand motion”in the right eye and 0.7 in the left eye. Based on a relative afferent pupillary defect and pallid optic disc edema identified on ophthalmological examination,we suspected arteritic anterior ischemic optic neuropathy of the right eye. Intravenous steroid therapy was initiated; however, the patient developed symptoms in the fellow eye. Histopathological evaluation of a temporal artery biopsy specimen revealed inflammatory cell infiltrates and giant cells. Tocilizumab（humanized anti-interleukin-6 receptor antibody）therapy was initiated, and steroid therapy was continued. Approximately on day 100 of the treatment course, her visual acuity stabilized to 0.02 and 0.3 in the right and left eyes, respectively. We conclude that tocilizumab could be a useful adjuvant to steroid therapy to treat severe arteritic anterior ischemic optic neuropathy.
