Abstract
Purpose :
The purpose of this study was to compare clinical outcomes between autoimmune retinopathy (AIR) patients treated with intravenous immunoglobulin (IVIg) and AIR patients who did not receive any treatment.
Methods :
We retrospectively reviewed the charts of patients diagnosed with AIR at Massachusetts Eye and Ear from 1988 to 2018.We identified patients who were either not treated or who were treated with IVIg. Clinical measures including visual acuity (VA), electroretinogram (ERG) parameters, and visual field (VF) area were recorded. For the natural history patients, these measures were analyzed at their first visit and last visits. For those patients treated with IVIg, the measures were analyzed at their last visit prior to starting IVIg and their most recent visit while receiving IVIg. The ttest was used to compare the mean change in VA between the two groups. Statistical tests were executed in STATA 12.1.
Results :
Ten patients with untreated AIR (4 men, 6 women, mean age = 55.8 years) and eight AIR patients treated with IVIg (5 men, 3 women, mean age = 56.3 years) were identified. Natural history patients’ VA declined at an average rate of 0.009 logMAR/month, while those treated with IVIg showed an average improvement of 0.012 logMAR/month. However, this difference was not statistically significant (P=0.26). Of patients with longitudinal ERG data, four (40%) of the natural history patients showed worsening of their ERG while six (60%) remained stable; four IVIg-treated (67%) patients remained stable, and two (33%) worsened. Of patients with longitudinal VF data, six (75%) natural history patients’ VF worsened, one (12.5%) improved, and one (12.5%) remained stable; one (25%) IVIg-treated patient worsened on VF, two (50%) improved, and one (25%) remained stable.
Conclusions :
Patients with untreated AIR had, on average, a gradual decline in VA, as well as stability or worsening of their VF and ERG. By comparison, patients treated with IVIg had, on average, a gradual improvement in VA, and were less likely to show a decline on ERG, and more likely to show an improvement on VF. This study is limited by its small sample size; however, it provides insight into the natural history and clinical course of AIR, and suggests that IVIg may be an effective therapy that warrants further investigation in a larger number of patients.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.