Intravenous immunoglobulin in recurrent-relapsing inflammatory optic neuropathy.
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).


METHODS
A semi-prospective case series from 4 medical centres.


METHODS
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.
Neuro-Ophthalmology Unit, Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel. kalishh@clalit.org.il
Hadas
H
Stiebel-Kalish
Naama
N
Hammel
Judith
J
van Everdingen
Ruth
R
Huna-Baron
Andrew G
AG
Lee
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000188:drug therapy* / Q000503:physiopathology*; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D014792:Visual Acuity / Q000187:drug effects; D014794:Visual Fields / Q000187:drug effects
D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous; D016572:Cyclosporine