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Erick Hernandez-Bogantes, J. Fernando Arevalo, Caio V. Regatieri, Jose A Roca, Michel E. Farah, Lihteh Wu; Intravitreal TNF-Alpha Inhibitors for Refractory Neovascular Age-Related Macular Degeneration: A Pilot Study from the Pan American Collaborative Retina Study (PACORES) Group. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1656. doi: https://doi.org/.
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To report the short term visual and anatomic outcomes following intravitreal injections of 2 different tissue necrosis factor (TNF) alpha inhibitors in eyes with choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) refractory to anti-VEGF agents.
A multicenter study of 20 eyes with refractory CNV that were injected with adalimumab (n=4 for 2 mg) or infliximab (n=8 for 1 mg; n=8 for 2 mg). The main outcome measures were the best corrected visual acuity (BCVA) and the central macular thickness (CMT) at 3 months of follow-up.
The mean log MAR BCVA changed from 1.04 ± 0.23 at baseline to 1.06 ± 0.51 at 3 months (p=0.9375) in the 1mg infliximab group; 0.94 ± 0.48 at baseline to 0.85 ± 0.43 in the 2 mg infliximab group (p=0.4375) and 1.58 ± 0.50 at baseline to 1.38 ± 0.43 in the adalimumab group (p=0.500). The mean CMT changed from 387 ± 54 µm at baseline to 342 ± 108 µm (p=0.2898) in the 1mg infliximab group; 301 ± 42 µm at baseline to 284 ± 73 µm (p=0.7548) in the 2 mg infliximab group and remained unchanged at 348 ± 106 µm (p=0.308) in the adalimumab group. Adverse events included uveitis in 37.5% (6/16) of eyes injected with infliximab.
Intravitreal infliximab and adalimumab do not appear to benefit eyes with refractory CNV secondary to AMD. Intravitreal injections of infliximab may elicit a severe intraocular inflammatory reaction.
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