The Role of Megadose Steroid Therapy in Neuro-Ophthalmology

In the late 1960's mega doses of intravenous methylprednisolone of approximately 30 mgs per kilogram delivered in seconds to 20 minutes (MDIV-MP) was shown to be effective in the treatment of all varieties of shock.' In the early 1970's MDIV-MP was shown to be efficacious in reversing acute renal graft rejection and subsequently in preventing development of renal graft rejection. Due to the similarity between the histopathologic process found in renal graft rejection and certain types of severe glomerular nephritis (proliferative and membranal proliferative), treatment with IV-MP in mega doses was used with good results. It was subsequently pointed out that there was a time window in which this modality was efficacious. As would be expected, if such a patient had severe hypertension, biopsy of the kidney usually demonstrated that the kidney was destroyed and in these oases, pulse Intravenous methylprednisolone had little effect.