Abstract

DO.22.05

Immunadsorption in patients with primary open-angle glaucoma

Anselm G. M. Jünemann1, Jürgen Rech2, Christopher Rössler1, Delia Baleanu1, Ursula Schlötzer-Schrehardt1, Rudolf Kunze3, Gerd Wallukat4, Friedrich E. Kruse1, Martin Herrmann2
1Universitäts-Augenklinik Erlangen, 2Labor für Zellbiologie, Institut für Immunologie, Universitätsklinikum Erlangen, Erlangen, 3Fresenius Medical Care, Bad Homburg, 4Max-Dellbrück Center, Berlin

Objective
In more than 70% of patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT) agonistic IgG3-autoantibodies (AAB) against G-Protein coupled ß2-receptor (ß2AR) were found using a bioassay1, 2. To study a possible role in the aequous humor dynamics of glaucoma, immunadsorption (IA) was performed in patients with POAG. The safety and pressure-reducing efficacy was analysed.
Methods
criteria was the presence of POAG with uncontrolled intraocular pressure (IOP) under maximal antiglaucomatous therapy and the refusion of surgical therapy. The age of the four patients (2 female, 2 male) was between 45 and 65 years. Selective IA was done using reusable absorbers (Globaffin®) on five consecutive days. Twice of the plasma volume was treated. The serum levels of AAB and immunglobuline (IgG, IgG3), and IOP were measured before IA and one week, 2 weeks, 4 weeks, 2, 4, 6, and 12 monats after IA.
Results
After IA no AAB were detectable in all patients. Serum levels of IgG and IgG3 reduced by 88-95% and 64-80%, respectively. Four weeks after IA serum levels of immunoglobulines recovered to normal values. In 2 patients AAB were detectable 4 months after IA, in the other 2 patients AAB remained undetectable during the follow-up. The IOP reduced in mean by 10%, the number of medications was 3.1± 0,9 before IA and 1.8±1.1 in the end the study. The IOP fluctuation reduced from 12.6mmHg to 5.6mmHg. The largest amount of IOP reduction was 23%.
Conclusions
The agonistic ß2AR-AAB can be washed out using selective immunadsorption. The results of this pilot study indicate a pressure-reducing effect of immunadsorption. Further studies are needed to analyse this effect in detail.
1) Dragun et al. N Engl J Med 2005; 352: 558-569
2) Junemann et al. IOVS 2006; 47; e-abstract 3384

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