Role of immunotherapy in complex treatment of acute optic neuritis associated with herpesvirus infection

Background. An increase in the incidence of optic neuritis (ON) among the workingage population, the complexity of etiological diagnosis and the choice of adequate etiotropic therapy, as well as a disappointing prognosis for vision due to the development of optic nerve atrophy determines the high social significance of this problem.

The aim. Comprehensive clinical, functional, morphometric and laboratory-immunological evaluation of results of using the drug Imunofan^® in combined treatment of ON associated with herpesvirus infection (HVI).

Materials and methods. The study involved 39 people (39 eyes) with acute ON associated with HVI. The standard treatment regimen for the patients included the appointment of solutions: dexamethasone in a decreasing scheme, a 1 % Emoxypine^® preparation 0.5 ml and 12.5 % Dicynone^® preparation 0.5 ml through an irrigation system implanted into the retrobulbar space, with subsequent appointment of medicinal means of neuroprotection (Picamilon^® and Semax^®). All patients were divided into two groups. The main group – 22 patients, whose standard inpatient treatment was supplemented with intramuscular administration of the drug Imunofan^®, 50 μg daily for 10 days. The control group consisted of 17 patients, who were treated only according to the standard method.

Results. Analysis of obtained data showed that more significant positive dynamics was noted in patients of the main group.

Conclusion. The clinical efficacy of the drug Imunofan^® in the complex therapy of ON associated with HVI was characterized by relief of signs of inflammation in the optic nerve in the main group immediately after the end of the course of treatment, while in the control group – only after 3 months; an increase in the best corrected visual acuity by 1.3 times, a decrease in the incidence of postneuritic optic nerve atrophy at a follow-up period of 12 months.

1. Avetisov SE, Egorov EA, Moshetova LK, Neroev VV, Takhchidi KhP. Ophthalmology. National Guidelines. Moscow: GEOTARMedia; 2019. (In Russ.).

2. Neroev VV, Zueva MV, Lysenko VS. Optical neuritis. Autoimmune diseases in neurology. Clinical Guide. Moscow, 2014; 1: 66-102. (In Russ.).

3. Shmidt TE. Differential diagnosis of optical neuritis: literature review. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2012; 112(9): 5-9. (In Russ.).

4. Kazimirchuk VE, Mal’tsev DV. Recommendations for the treatment of human herpesvirus infections. Ukraїns’kiy medichniy chasopis. 2012; 5(91): 94-106. (In Russ.).

5. Klimov VV, Cherevko NA, Denisov AA, Kologrivova EN. Clinical Immunology and Allergology. Tomsk; 2008. (In Russ.).

6. Isakov VA, Rybalkin SB, Romancov MG. Human Herpesvirus Infection: A Guide for Physicians. Saint Petersburg; 2013. (In Russ.).

7. Danilova LP, Smoliakova GP, Emanova LP. Method of complex therapy of optic neuritis. Patent N 2320300 of the Russian Federation; 2008; (9). (In Russ.).

8. Arvin A, Campadelli-Fiume G, Mocarski E, Moore PS, RoizmanB, Whitley R, etal. Human herpesviruses: Biology, therapy, and immunoprophylaxis. Cambridge: Cambridge University Press; 2007.

9. Chernakova GM, Arzhimatova GSh, Kleshcheva EA, Semenova TB. Ophthalmoherpes: Etiology, clinical features and therapy perspectives. TERRA MEDICA. 2015; 1(79): 61-65. (In Russ.).

10. Sdobnikova SV, Тroitskaya NA, Surnina ZV, Pateyuk LS. General and ophthalmic manifestations of herpes virus infections. Ophthalmology in Russia. 2016; 13(4): 228-234. (In Russ.). doi: 10.18008/1816-5095-2016-4-228-234

11. Chernakova GM, Arzhimatova GSh, Kleshcheva EA, Semenova TB. Herpesviruses in ophthalmology. Vestnik oftal’mologii. 2014; 130(4): 127-131. (In Russ.).

12. Velichko TV, Katargina LA, Krichesvskaya GI, Slepova OS. The role of activation of persistent herpesvirus infection during recurrent endogenous uveitis in children. Epidemiologiya i infektsionnye bolezni. 2003; (5): 52-55. (In Russ.).

13. Kovalchuk LV, Martirosova NI, Sokolova EV, Levchenko VA. Principal trends of immunotherapy in ophthalmology. Review. Refraktsionnaya khirurgiya i oftal’mologiya. 2008; 8(2): 45-50. (In Russ.).

14. Picamilon – metabolic cerebrovascular agent and nootropic. Application in medical practice. Moscow: Akrikhin; 2002. (In Russ.).