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Pichaporn Artornsombudh, Ofelya Gevorgyan, Abhishek Payal, Sana Siddique, Charles S. Foster; Infliximab treatment of birdshot retinochoroidopathy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1180.
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To report the outcomes of infliximab treatment for birdshot retinochoroidopathy (BSRC) refractory to conventional immunomodulatory therapy.
All refractory birdshot retinochoroidopathy patients from July 2005 to October 2011 were identified from retrospective chart review. All patients received 5 mg/kg of Infliximab at 4-8 week intervals. Demographic data, usage of immunosuppressive drug, biologic agent, and reason for conventional therapy discontinuation were gathered. Disease activity monitoring including signs of ocular inflammation, fluorescein angiography (FA) evidence of retinal vasculitis or papillitis, indocyanine green angiography (ICG) evidence of active choroiditis, electroretinography (ERG) parameters indicative of active or worsening of retinal function, and optical coherence tomography (OCT) findings indicative of static or worsening macular edema were recorded. The outcome features of primary interest were abolition of all evidence of active inflammation, visual acuity (VA), and presence of cystoid macular edema (CME). We assessed the outcomes of infliximab therapy at 6 months and 1 year follow up. Adverse events of Infliximab were also tabulated.
Twenty two patients, 44 eyes, were included in the study. Mean duration of disease before starting infliximab was 58.62 months. Mean duration on Infliximab was 13.55 months. Prior to Infliximab therapy, all patients received and failed conventional immunosuppressive therapy. Ten patients had received another biologic agent. After initiating Infliximab, control of inflammation was achieved at 6 months in 81.82% and 75% at 1 year. Three patients had active inflammation during therapy. Cystoid macular edema decreased from 22.73% at baseline to 13.89% at 6 months and 5.56% at 1 year after receiving drug. Initial visual acuity 20/40 or better was found in 34 eyes (84.09%). At 6 months and 1 year, 91.67% and 94.44% of eyes retrospectively had VA 20/40 or better. Six patients developed adverse events, requiring discontinuation of therapy due to Guillain Barre Syndrome, drug induced lupus, allergic reaction, and fungal infection.
The data suggest that Infliximab may be effective for controlling inflammation in otherwise treatment refractory cases of BSRC.
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