Abstract
Purpose:
To assess the effect of infliximab on inducing remission in patients with uveitis associated with retinal vasculitis.
Methods:
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.
Results:
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.
Conclusions:
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.
Keywords: 555 immunomodulation/immunoregulation •
746 uveitis-clinical/animal model •
688 retina