Benefit of intravenous immu>oglobulin in patients with refractory uveitis: preliminary results

Purpose. Severe uveitis may fail to respond to immunosuppressive medications such as corticosteroids, cyclosporine, antimetabolits, or alkylating drugs. Intravenous immunoglobulin (IVIg) is effective in a variety of autoimmune diseases including juvenile dermatomyositis, idiopathic thrombocytopetiic purpura, and Guillain-Barre syndrome. Methods. We conducted an open label study on the benefits of IVIg(Baxter Pharmaceuticals) (0.5 gm/kg daily times 3 ind repeated monthly) for 6 patients whose bilateral uveitis had not responded to oral immunosuppressive medications. Five patients were female. The average age was 41 yrs.; the average duration of uveitis prior to IVIg was 5.9 yrs.; the median visual acuity prio' to treatment was 20/80 to 20/100. One patient had sarcoidosis; one had Behcet's; one had birdshot choroidopathy; one had pars planitis; and two had idiopathic disease. Results. From baseline examination to final follow-up four of six patients experienced :l or more lines of improvement in visual acuity (ETDRS scale) in at least one eye and a fif Ji patient experienced 2 lines of improvement in each eye. The average length of follow-up has been 5.4 months (range 1.5 to 9 months). The patient with sarcoidosis was able to discontinue prednisone and methotrexate while reducing cyclosporine dosage; die patient with Behcet's discontinued azathioprine and cyclosporine while experiencing improved ;ontrol of his systemic disease. No significant toxicity was reported. Conclusion;. These preliminary observations are based on a small number of patients with limited follow-up. However, the results are superior to what we have previously achieved with other immunosuppressive medications including intravenous ;yclophosphamide. IVIg should be considered for patients with refractory uveitis, but cost and proof of long term efficacy should lim t its current use.