Abstract
Purpose :
Neuropathic pain is caused by an injury to the somatosensorial nervous system and can affect the cornea. Immune-mediated mechanisms have been defined in the pathophysiology and intravenous immunoglobulin (IVIG) has been reported to be an efficient treatment in immune-mediated small fiber neuropathy (SFN) patients. We aimed to evaluate the efficacy of IVIG treatment in patients with neuropathic corneal pain (NCP).
Methods :
Medical records of patients who were diagnosed with NCP and SFN based on clinical, in vivo corneal confocal microscopic, and positive skin biopsy findings, and were initiated with IVIG treatment were evaluated. All patients underwent detailed serological evaluation for auto-/dyimmune antibodies (Abs). Demographic features of patients, corneal fluorescein staining (CFS) scores (Oxford scale), ocular pain assessment survey (OPAS) scores, and ocular surface disease index (OSDI) scores were reviewed at baseline and 6-months treatment follow-up.
Results :
Fourteen NCP patients who were refractory to topical and systemic therapies were included. The mean age of patients was 43.2±13.3 years. Twelve patients had at least one positive auto-/dysimmne Ab. Two patients had negative results for Ab screening while presenting strong clinical suspicion for potential underlying autoimmunity. Ocular surface staining was not detected in 13 of the patients, 1 had +3 CFS. Four patients discontinued the treatment before 6 months (2 patients after 1month and 2 patients after 3 months) due to side effects (headache (n=2) and systemic Staphylococcal infection (n=1)) or insurance denial (n=1). In the remaining 10 patients, the mean pain intensity score (scale 0-10) in the last 24 hours and in the last 2 weeks improved from 5.4±0.8 to 3.6±0.9 (p=0.004) and from 5.0±0.9 to 3.7±0.9 (p=0.02), respectively. The impact of pain on quality of life reduced significantly in the follow-up visit (from 6.0±2.9 to 4.3±2.9, p=0.03). Overall, patients reported a mean of 32.5% eye pain relief compared to their baseline visit. The mean OSDI score (0-100) did not show significant changes between visits (58.3±25.6 vs 56.2±24.0, p=0.46).
Conclusions :
IVIG treatment provides significant pain relief and improves the quality of life in NCP patients. Therefore, in selected cases, IVIG treatment seems to be promising in NCP management, when refractory to other therapies.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.