Neuro-Ophthalmology Unit, Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.
Can J Ophthalmol. 2010 Feb;45(1):71-5. doi: 10.3129/i09-238.
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).
A semi-prospective case series from 4 medical centres.
Patients with steroid responsive recurrent-relapsing optic neuropathy.
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.
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.
IVIg can be considered an effective steroid-sparing agent in selected cases with steroid-dependent recurrent-relapsing autoimmune optic neuropathy.
复发性-缓解性炎性视神经病变，包括慢性复发性炎症性和自身免疫性视神经病变，较为罕见，但可导致严重的视力丧失。长期使用类固醇可能有助于保留视力，但副作用较为常见。我们介绍了静脉注射免疫球蛋白（IVIg）的应用经验。
来自 4 家医疗中心的半前瞻性病例系列研究。
对类固醇有反应的复发性-缓解性视神经病变患者。
4 家医疗中心对类固醇反应性复发性-缓解性视神经病变患者进行 IVIg 治疗的半前瞻性病例系列研究。主要观察指标包括视力结果、缓解时间和持续时间、皮质类固醇使用时间以及不良反应。
6 例接受 IVIg 治疗且不长期使用类固醇的患者视力均稳定，无一例改善或恶化。1 例在 IVIg 维持治疗 3 年后发生 1 次 IVIg 输注相关不良事件。在接受 IVIg 治疗之前，平均使用皮质类固醇 12 个月。接受 IVIg 治疗后，6 例患者中有 5 例不再需要使用皮质类固醇。2 例患者在接受 IVIg 治疗后出现迟发性复发，其中 1 例接受环孢素治疗，另 1 例接受皮质类固醇治疗。
对于某些对类固醇有依赖性的复发性自身免疫性视神经病变患者，IVIg 可被视为一种有效的类固醇节约剂。
