The Efficacy of Infliximab in Refractory Uveitis

PURPOSE: To investigate the effectiveness of infliximab as treatment for refractory uveitis that recurred in spite of immunosuppressive agents. METHODS: Thirty patients who were treated for refractory uveitis from 2002 to 2011 were included in this study. We retrospectively reviewed the medical records of 15 patients who were treated with Infliximab and 15 patients not treated with Infliximab. Infliximab was injected intravenously (5 mg/kg) 3 times every 4 weeks, and the patients were followed-up at 1 week, 2 weeks, and every month thereafter. Anterior chamber cell reaction with a score greater than 0.5+ was defined as recurrence of uveitis. RESULTS: Among 15 patients treated with Infliximab, only one showed no response to the medication. The recurrence rate was significantly higher in patients receiving Infliximab treatment (1.1 +/- 0.2 times) than in those not receiving Infliximab treatment (3.1 +/- 0.3 times) (p=0.022). CONCLUSIONS: Infliximab can be used effectively on patients with refractory uveitis. However, a future prospective randomized study is needed to demonstrate the effectiveness of Infliximab and to determine an accurate protocol regarding dosage and number of injections.

The Effect of Anti-TNF-alpha on Refractory Uveitis

PURPOSE: To investigate the effects of Anti-TNF-alpha (infliximab, Remicade(R), Shering-Plough) on refractory uveitis. METHODS: A retrospective observational survey was conducted on 12 eyes of 10 patients with refractory uveitis. These patients had no response to immunosuppresants or systemic steroid therapy and were intolerable due to drug toxicity. After an intravenous injection of Anti-TNF-alpha, best corrected visulal acuity was measured. Improvement in inflammation was then observed at the first, third and last month of follow-up. RESULTS: Patients were observed for a mean period of 15 months. They received anti-TNF-alpha intravenously, ranging from one to eleven infusions. After infusion with Anti-TNF-alpha, remission of intraocular inflammation was evident in all patients within 9.7 days. Best corrected visual acuity also improved at the first, third, and last month of follow-up. Two patients were infected by tuberculosis and mumps respectively. CONCLUSIONS: There was an effect on refractory uveitis with anti-TNF-alpha therapy. Many participants may also require further evaluation after treatment.

Intravitreal Injection of Triamcinolone Acetonide on Refractory Uveitis

PURPOSE: To investigate the effect of intravitreal injection of triamcinolone acetonide (4 mg) on refractory uveitis with cystoid macular edema (CME). METHODS: A retrospective observation survey was conducted on 21 eyes of 15 patients with refractory uveitis that had no response to immunosuppresants or systemic steroid therapy. Seven eyes were injected with triamcinolone acetonide intravitreally only, and fourteen eyes were injected during pars plana vitrectomy. At 3 and 12 months after triamcinolone acetonide injection, best corrected visual acuity and thickness of macula were measured by OCT. RESULTS: The average pre-treatment best corrected visual acuity was 0.18+/-0.08, and the average macular thickness was 534+/-132 micrometer. At 3 months after injection, the results for the same parameters were 0.45+/-0.18, 345+/-125 micrometer respectively. At 12 months after injection, they were 0.30+/-0.09, 498+/-133 micrometer respectively. Thus, best corrected visual acuity had improved and macular thickness had decreased at 3 months post-injection for the groups with intravitreal injection of triamcinolone acetonide and intravitreal injection during pars plana vitrectomy. However, these changes in best corrected visual acuity and macular thickness were not observed 12 months after injection. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide had a temporary effect on refractory uveitis with cystoid macular edema (CME). However, a study that includes more participants will be necessary for conclusive evaluation.