Intravenous immune globulin (IVIg) can be beneficial in several immune-mediated and inflammatory disorders [1, 2]. The administration of IVIg was recently reported to significantly reduce the necessary dose of corticosteroids in patients with severe steroid-dependent asthma, suggesting that IVIg could be used as a steroid-sparing agent in patients with chronic inflammatory conditions [3].

Birdshot retinochoroidopathy is a chronic bilateral form of posterior uveitis of autoimmune origin strongly associated with HLA-A29. If untreated, it results in photophobia, night blindness, altered visual fields, and, eventually, visual loss [4]. Patients with severe birdshot retinochoroidopathy require long-term therapy with steroids or cyclosporine. The frequent occurrence of side effects, including cataract, osteoporosis, diabetes, and hypertension, can limit therapy.

We describe five patients with severe birdshot retinochoroidopathy in whom the administration of IVIg permitted a significant reduction in the daily requirement of prednisone. The mean duration of the disease (±SD) before initiation of IVIg was 35 ± 26 months. Before IVIg, the mean daily intake of prednisone was 55 ± 16 mg. The dosage was 0.8 g/kg of body weight per day for 2 consecutive days every 2 months for 4 to 32 months. During the follow-up period (Table 1), mean visual acuity, assessed in 10 eyes, increased from 0.57 ± 0.24 to 0.76 ± 0.16 (P = 0.01). The mean daily dosage of prednisone was decreased sixfold, from 55 ± 16 to 9 ± 7 mg (P = 0.04). In patient 3, steroid treatment was discontinued after 12 courses of IVIg; this patient had received corticosteroids for 72 months before the initiation of IVIg therapy.

Our observations support the need for controlled trials to demonstrate the efficacy and assess the cost-effectiveness of IVIg as a steroid-sparing agent in patients with chronic inflammatory conditions.