Intravenous immunoglobulin in recurrent-relapsing inflammatory optic neuropathy

Abstract Objective: Recurrent-relapsing inflammatory optic neuropathy, including chronic relapsing inflammatory and autoimmune optic neuropathies, is rare, but can cause severe visual loss. Long-term steroids may preserve vision, yet side effects are frequent. We describe our experience with intrave...

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Bibliographic Details
Published in:Canadian journal of ophthalmology 2010-02, Vol.45 (1), p.71-75
Main Authors: Stiebel-Kalish, Hadas, MD, Hammel, Naama, MD, van Everdingen, Judith, Huna-Baron, Ruth, Lee, Andrew G., MD
Format: Article
Language:English
Subjects:
Adrenal Cortex Hormones - administration & dosage
Adult
Cyclosporine - therapeutic use
Female
Humans
immune system disease
Immunoglobulins, Intravenous - adverse effects
Immunoglobulins, Intravenous - therapeutic use
immunology
Internal Medicine
Male
Middle Aged
neuro-ophthalmology
Ophthalmology
Optic Nerve Diseases - drug therapy
Optic Nerve Diseases - physiopathology
optic neuritis
Prospective Studies
Recurrence
Treatment Outcome
Visual Acuity - drug effects
Visual Fields - drug effects
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Summary:Abstract Objective: Recurrent-relapsing inflammatory optic neuropathy, including chronic relapsing inflammatory and autoimmune optic neuropathies, is rare, but can cause severe visual loss. Long-term steroids may preserve vision, yet side effects are frequent. We describe our experience with intravenous immunoglobulins (IVIg). Design: A semi-prospective case series from 4 medical centres. Participants: Patients with steroid responsive recurrent-relapsing optic neuropathy. Methods: Semiprospective case series of IVIg treatment in steroid-responsive recurrent-relapsing optic neuropathy at 4 medical centres. Outcome measures included visual outcome; time to, and duration of, remission; duration of corticosteroid use; and adverse events. Results: Vision stabilized in all 6 patients treated with IVIg without steroids for extended periods of time. None improved and none worsened. One adverse event occurred during an IVIg infusion after 3 uneventful years of IVIg maintenance. Average steroid use prior to IVIg was 12 months. After IVIg treatment, 5/6 patients no longer required corticosteroids. Two patients experienced late relapses on IVIg, one of whom was treated with cyclosporine, the other with steroids. Conclusions: IVIg can be considered an effective steroid-sparing agent in selected cases with steroid-dependent recurrent-relapsing autoimmune optic neuropathy.
ISSN:0008-4182
1715-3360
DOI:10.3129/i09-238