June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Efficacy of Intravenous Immunoglobulin (IVIG) Treatment in Patients with Neuropathic Corneal Pain
Author Affiliations & Notes
  • Betul Bayraktutar
    Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts, United States
  • Khosro Farhad
    Department of Neurology, Harvard Medical School, Boston, Massachusetts, United States
  • Oscar Soto
    Department of Neurology, Tufts Medical Center, Boston, Massachusetts, United States
  • Pedram Hamrah
    Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Betul Bayraktutar None; Khosro Farhad None; Oscar Soto None; Pedram Hamrah Kala, Novartis, Dompe, Clementia, Novaliq, Santen, Code C (Consultant/Contractor), Novartis, Oyster Point, Dompe, Code S (non-remunerative)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 1225 – A0225. doi:
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    • Get Citation

      Betul Bayraktutar, Khosro Farhad, Oscar Soto, Pedram Hamrah; Efficacy of Intravenous Immunoglobulin (IVIG) Treatment in Patients with Neuropathic Corneal Pain. Invest. Ophthalmol. Vis. Sci. 2022;63(7):1225 – A0225.

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      © ARVO (1962-2015); The Authors (2016-present)

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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.

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