Seeing is believing: A review of apheresis therapy in the treatment of ophthalmologic disease

Abstract

Apheresis procedures have a role in treatment of disparate diseases involving many different organ systems. Often the disease processes where apheresis plays a role in treatment are considered "orphan diseases"-relatively rare disease processes that lack specific pharmaceutical agents or established treatment protocols. Many of these disease processes can affect the eye with devastating results for the eyesight of these patients. The unique ability of apheresis to affect disease by modifying blood plasma and modulating disease-causing agents therein renders apheresis procedures valuable tools in the treatment of certain ophthalmologic diseases. This review comprehensively evaluates the role of apheresis in the treatment of ophthalmologic diseases of the eye and surrounding orbit including age-related macular degeneration, bilateral diffuse uveal melanocytic proliferation, paraneoplastic retinopathy, atopic keratoconjunctivitis, sympathetic ophthalmia, and endocrine-associated ophthalmopathy. Apheresis procedure parameters are provided for the apheresis practitioner based on review of the relevant literature.

Sympathetic Ophthalmia: Where Do We Currently Stand on Treatment Strategies?

“…Graham et al 170 studied apheresis therapy in the treatment of ophthalmologic diseases including SO. Apheresis affects the disease by modifying blood plasma and modulating disease-causing agents.…”

Plasmapheresis in Ophthalmology

“…Thus, not only the IgM level decreases by 46.5% and viscosity of blood -by 44,7%, but also the diameter of the dilated veins decreases by 15.3%, leading to the venous blood-flow increase by 55.2% [38,39]. Apheresis therapy allows the removal of these pathological products to delay or relieve vascular disorders [59].…”

“…To treat this condition in addition to immunosuppressive therapy it is necessary to resort to enucleation of the affected eye to reduce the scale of lesions of the healthy one [68]. However, direct removal of the formed autoantibodies from the body is also indicated by means of plasmapheresis [59,69].…”

“…Adenovirus type 8B, 19B, 37B and 54B can promote even epidemic outbreak of keratoconjunctivitis [124]. Steroid therapy is used but, given the autoimmune nature of the disease, plasmapheresis is also performed [59,125].…”

“…Bilateral diffuse melanocytic proliferation of the vascular membrane of the eye is a type of paraneoplastic syndrome. Plasmapheresis prevents the thickening of the eye choroid, which improves the sight [59,153].…”