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F. B. Porto, S. Sampaio; Intravitreal Infliximab Injection for Unresponsive Cystoid Macular Edema Associated With Inactive Retinal Vasculitis. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2812.
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To report three patients under imunossupressive therapy who presented inactive retinal vasculitis and impaired visual acuity because of chronic macular edema (ME) treated with intravitreal anti-TNF monoclonal antibody infliximab.
Intravitreal infliximab was offered to treat one legally blind eye of consented patients who presented inactive retinal vasculitis and were losing vision due to chronic macular edema.
A total of 3 legally blind eyes of 3 patients (two males and one female) with inactive retinal vasculitis, no clinically evident ocular inflammation and refractory macular edema (mean duration 26 months) were treated. Before treatment, OCT shows an increase of the macular thickness (3/3), intra- (3/3) and sub-retinal fluid (2/3); epi-retinal membrane (1/3). After treatment, the foveal thickness decreased in the study eye (CMT -41, -4, -9 microns; AF -31, -6, -1 microns) and also in the fellow eye (CMT -208, -127, -22 microns; AF -209, -218, -16 microns). The foveal anatomy restored to a significant level. The BCVA get worse at week 1 (3/3) and significantly improved thereafter. The macular electrical responses of the mERG recording depicted a substantial worse in the electrical responses in the fovea and parafovea at week 1, with a gradual recovering since then (3/3). No patient manifested IOP increase or intraocular inflammation. No ocular or extra-ocular side effects were noted.
III injection appears to be very helpful for the resolution of chronic CME and for visual recovery, but we would like to emphasize the risk of retinal toxicity. A controlled trial is warranted to define toxic and therapeutical dose, as well as duration of the effect of this promising drug.
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