[CIS PIDD] [cis-pidd] Eye disease in CVID

Wed Nov 30 14:32:48 EST 2016

We have used autologous serum for the treatment of similar features in the post HSCT GVHD setting with good success.  Basically serum is sterilely collected from the patient, filtered and aliquoted into single use vials for daily use bid to qid.

I proposed years ago to develop an IgG product for ophthalmologic use.  There is a broad Japanese patent regarding this.

Terry Harville MD PhD D(ABMLI) D(ABHI)
*Medical Director, Histocompatibility Laboratory
*Medical Director, Immunogenetics and Transplantation Laboratory
*Specialist in Pediatric Allergy, Asthma, Immunology, Rheumatology, Autoimmunity, Hematopoietic Stem cell Transplantation for Immunodeficiencies, and Organ Transplantation Immunology
*Diplomate of the American Board of Medical Laboratory Immunology – specializing in diagnostic evaluations of immunodeficiencies
*Diplomate of the American Board of Histocompatibility and Immunogenetics – specializing in pre- and post-transplantation diagnostic evaluations, disease associations, and platelet transfusion support

Departments of Pathology and Laboratory Services and Pediatrics
University of Arkansas for Medical Sciences
4301 West Markham
Mail Slot #502
Little Rock, AR  72205-7199

Email:.................................harvilleterryo at uams.edu

Office Phone 1....................................501.526.7511
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Office Fax........................................501.526.4621
Histocompatibility Laboratory.....................501.686.7257
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Immunogenetics and Transplantation Laboratory.....501.686.7374

From: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org]
Sent: Wednesday, November 30, 2016 10:47 AM
To: CIS-PIDD <cis-pidd at lyris.dundee.net>
Subject: Re: [cis-pidd] Eye disease in CVID

You don't say if the IgG is endogenous or supplemented. I had a similar patient who problem resolved on IG supplementation. If she is already being supplemented, I think you are left with local treatment. I wonder if anyone has tried IG as an eye drop?
Richard Wasserman
Dallas

On Wed, Nov 30, 2016 at 10:36 AM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>> wrote:
In the GvH setting, we’ve used cyclosporine eye drops (restasis). There was a study on a CsA implant, but I don’t think that that is commercially available (paper attached). If the ophthalmologist wants objective evidence of ocular autoimmunity prior to using restasis, he could do a meibomian gland biopsy. A number of meibographic techniques have been described as well, and the ophthalmologist might be familiar with that as a non-invasive alternative
-R

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From: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>]
Sent: Wednesday, November 30, 2016 11:14 AM
To: CIS-PIDD
Subject: [cis-pidd] Eye disease in CVID

Dear colleagues,

We have a 55-yo white female with CVID, who has suffered from severe bilateral blepharitis, episcleritis, and dry eye for 2 years now to the point that she has lost all eyelashes. So far there is no evidence of uveitis or retinal diseases. No improvement from steroids eye drops or oral.

Her ophthalmologist is at a loss in how to proceed. I was wondering if her eyelid and scleral diseases are related to CVID. She is otherwise doing well from infection standpoint, IgG levels >1,000 on IVIG, IgA 10s, and IgM 20-30s. She does not have dry mouth, autoimmune manifestations, or lymphoid infiltrations. Her T, B cell counts and their subsets are normal.

Does anyone have experience with CVID patients like this? I would appreciate comments or suggestions. I looked up the literature and most reports of eye diseases in CVID are more of uveitis or retinal diseases, similar to those seen in sarcoidosis.

Thank you,
Panida

Panida Sriaroon, MD
Associate Professor
Associate Director, Fellowship Program
Medical Director, USF/All Children's Hospital Allergy/Immunology clinic
E-mail  psriaroo at health.usf.edu<mailto:psriaroo at health.usf.edu>

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