title: Clinical outcomes of intravenous immunoglobulin therapy in refractory uveitis.
abstract: Intravenous immunoglobulin (IVIg) therapy has multiple mechanisms of immunomodulatory action. We wished therefore to assess its efficacy in a spectrum of patients with refractory uveitis. Retrospective review of clinical charts was conducted to document response to IVIg treatment in consecutive patients with treatment-refractory uveitis. Main outcome measures were control of intraocular inflammation, visual acuity, progression of the disease, and complications. Four (two male) patients, with a mean age at the beginning of the treatment of 47 years (range: 39-64), were included in the study. Indication for treatment was patients with active non-infectious uveitis refractory to steroids and immunomodulatory therapy. All patients received a course of 0.5 g/kg per day of IVIg for three consecutive days, repeating this course at a mean of 11 week (range: 2-39 weeks) intervals when indicated clinically. The median duration of the IVIg therapy was 7 months (range: 3-14 months). In three patients treatment resulted in stabilisation and prevention of progression of the disease, and additionally in two patients it facilitated a decrease in prednisolone dose. Treatment failed to induce long-term remission in one patient with recurrence of macular oedema. IVIg was well tolerated with neither immediate nor longer-term adverse events observed. In three out of four cases IVIg was an effective adjunctive therapy and well tolerated for the management of treatment-refractory uveitis.
authors.affiliation: Medical Retina and Uveitis Department, Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin Street, Bristol, BS1 2LX, UK.
authors.forename: M
authors.initials: M
authors.lastname: Garcia-Geremias
authors.forename: E
authors.initials: E
authors.lastname: Carreño
authors.forename: S J
authors.initials: SJ
authors.lastname: Epps
authors.forename: R W J
authors.initials: RW
authors.lastname: Lee
authors.forename: A D
authors.initials: AD
authors.lastname: Dick
mesh_terms: D000328:Adult; D018450:Disease Progression; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007155:Immunologic Factors / Q000008:administration & dosage*; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014605:Uveitis / Q000188:drug therapy*; D014792:Visual Acuity
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors