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Pramod Sharma, Gueorgui Markov, C. Stephen Foster; Response of uveitis-related retinal vasculitis to therapy with systemic infliximab. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2052.
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To assess the effect of infliximab on inducing remission in patients with uveitis associated with retinal vasculitis.
Retrospective case series study of the clinical records of 48 consecutive patients, who received infliximab for uveitis with associated vasculitis at MERSI, between 7/2005 and 7/2012, for at least 12 months. Effect was assessed on the basis of findings from fluorescein angiography and optical coherence tomography.
From all 48 patients (100%) with uveitis and retinal vasculitis, 12 (25%) were male, and 36 (75%) - female. Age varied from 10 to 70 years. A total of 91 eyes were affected. Follow-up was from 12 to 78 months. Anterior uvetitis was diagnosed in 3(6.25%), intermediate - in 7 (14.58%), posterior - in 11(22.91%), panuveitis - in 12(25%),scleritis in 1(2.08). In addition we had birdshot retinochoroidopathy in 7 cases (14.58%), Behcet’s disease in 6(12.5%), and sympathetic ophthalmia in 1 (2.08%). Average dose of Infliximab was 5mg/kg. Sustained control of inflammation was achieved in 40 (83.3%) out of 48 patients. Average time for control of vasculitis was from 3 to 6 months In 2 cases infliximab was discontinued due to rise of liver enzymes. One (2.08%) case improved after rescue therapy with cyclophosphamide. One (2.08%) developed optic nerve demyelination. 2 (4.1%) cases developed lupus-like rash. One patient (2.08%) improved after pars plana vitrectomy and/or periocular or intravitreal corticosteroid injections. Relapses occurred due to temporary discontinuation of infliximab secondary to flu or pneumonia in one patient (2.08%). 1 (2.08%) had a relapse after stretching of infusion interval but subsequently improved on decreasing the interval. One patient (2.08%) showed good response but had to stop due to insurance issues. 1 (2.08) achieved remission without needing further therapy.
Uveitis associated with retinal vasculitis is a sight-threatening condition necessitating immunomodulatory therapy in a large percentage of patients. Infliximab appears to be a useful therapeutic agent which can lead to a sustained control of inflammation over a long period of follow-up.
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