Apheresis Therapy for Retinal Vasculitis

We read with interest the case reports by Papadaki et al¹ in the November 2006 issue of the Archives. Their results in treating patients with lupus retinal vasculitis were similar to our earlier work using low-density lipoprotein apheresis.² Unlike plasmapheresis, low-density lipoprotein apheresis does not remove albumin or immunoglobulins and has little effect on high-density lipoprotein cholesterol levels. In addition to immediately reducing low-density lipoprotein cholesterol levels by 60% to 80%, low-density lipoprotein apheresis lowers plasma levels of vascular markers, reduces blood viscosity, and improves endothelial function.³ We hypothesize that these changes could lead to an increase of microvascular flow, which may be of major significance during the acute lupus crisis. We concur with Papadaki and colleagues that apheresis may be useful as an adjunctive therapy for retinal vasculitis when immunosuppressants alone are ineffective.