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Michal Kramer, Michal Schaap-Fogler, Ronit Friling, Ethan Priel, Radgonde Amer; <Efficacy Of Anti Tumor-necrosis-factor (TNF) - alpha Agents For Cystoid Macular Edema (cme) Related To Uveitis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3199.
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To evaluate the efficacy of anti TNF-α agents, compared to other immunosuppressive therapies for uveitis-related CME.
A retrospective analysis of patients treated for CME at the uveitis services of two tertiary centers in Israel, between 2007- 2011. Data included demographic details, visual acuity (VA) and OCT measurements at the time of treatment initiation and at 3, 6, and 12 months follow up. Patients who were treated with conventional immunosuppressive therapy prior to anti TNF-α agents were evaluated in both groups.
Eighteen patients (27 eyes) (Group A) were treated with conventional immunosuppressive therapy for chronic CME, which included periocular and systemic steroids, methotrexate, azathioprine, cyclosporine, and mycophenolate. Nine patients (15 eyes) (Group B) were treated with either infliximab or adalimumab. Mean duration of CME prior to initiation of anti TNF - α therapy was 13±11 months. Mean central macular thickness (CMT) and mean visual acuity (VA) were similar at baseline for both groups. Significant reduction in CMT was evident at all time points for both groups; most significant at 3 months for group A and at 6 months for group B (515±228 μm at baseline vs 235±73 μm, p=0.002), with a slightly reduced effect at 12 months. Mean VA improved in both groups, with maximal improvement at 3 months (group A p=0.03; group B p=0.01), and a reduced effect towards 12 months. Mean VA at 12 months was similar for both groups.
Treatment of uveitis-related CME with anti TNF-α agents is efficient and lasting. Given the fact that anti TNF-α agents were used when conventional immunosuppressive agents failed, it seems that their favorable effect takes action on long standing CME. The role of anti TNF- α treatment as a first line therapy should be further investigated.
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