Ocular Inflammation/Immunology Service, Genimatas General Hospital, Athens, Greece.
Am J Ophthalmol. 2012 Sep;154(3):534-541.e1. doi: 10.1016/j.ajo.2012.03.035. Epub 2012 Jul 11.
To assess the safety and to conduct a preliminary assessment of efficacy of intravitreal infliximab, an anti-tumor necrosis factor antibody, for sight-threatening relapsing uveitis in Behçet disease.
Prospective, noncomparative, interventional pilot study.
A single intravitreal injection of infliximab (1 mg/0.05 mL) was given to 15 patients with relapsing posterior uveitis at the onset of a unilateral attack. Best-corrected visual acuity, anterior chamber cells, vitreous haze, and posterior eye segment inflammation were assessed at baseline and at 1, 7, 14, and 30 days after treatment.
Ocular or extra-ocular side effects were not observed. Baseline best-corrected visual acuity (mean logarithm of minimal angle of resolution, 0.74; range, 0.15 to 1.7) improved significantly by day 7 and continued to improve through day 30 after infliximab (mean, 0.30; P < .0001). Profound decreases in anterior chamber cells and vitreous haze (both P < .0001), as well as beneficial effects in retinal vasculitis (P = .0001) and retinitis (P = .001) were evident through day 30. Cystoid macular edema persisted in 9 of 11 eyes affected, but central macular thickness decreased from a baseline mean of 434 to 309 mm at the end of follow-up (P < .0001). Lack of systemic treatment at baseline in 4 patients or background immunosuppressive medications, which remained unchanged during follow-up, did not influence significantly these responses; additional treatment was not required.
These findings suggest that intraocularly produced or acting tumor necrosis factor, or both, is crucial in Behçet disease-associated relapsing uveitis and that intravitreal infliximab should be considered when systemic administration is not feasible or contraindicated. Further studies may identify patients for whom intravitreal infliximab is preferable to systemic treatment.
评估玻璃体腔内注射英夫利昔单抗（一种抗肿瘤坏死因子抗体）治疗 Behcet 病致威胁视力的复发性葡萄膜炎的安全性和初步疗效。
前瞻性、非对照、干预性初步研究。
15 例单侧发作的后部葡萄膜炎复发患者在疾病发作时接受单次玻璃体腔内注射英夫利昔单抗（1 mg/0.05 mL）。在治疗前、治疗后 1、7、14 和 30 天评估最佳矫正视力、前房细胞、玻璃体混浊和后节炎症。
未观察到眼内或眼外副作用。治疗前最佳矫正视力（最小分辨角对数均值，0.74；范围，0.15 至 1.7）在治疗后第 7 天显著改善，并持续至第 30 天（平均，0.30；P<0.0001）。前房细胞和玻璃体混浊显著减少（均 P<0.0001），视网膜血管炎（P=0.0001）和视网膜炎（P=0.001）有效，这些均在第 30 天观察到。11 只受影响眼中有 9 只仍存在囊样黄斑水肿，但在随访结束时中央黄斑厚度从基线的平均 434 μm 降至 309 μm（P<0.0001）。4 例患者治疗前未接受全身治疗或背景免疫抑制治疗且在随访期间未改变，这些因素对上述反应无显著影响，无需进一步治疗。
这些发现提示眼内产生或作用的肿瘤坏死因子或两者均在 Behcet 病相关复发性葡萄膜炎中起关键作用，当全身给药不可行或禁忌时，应考虑玻璃体腔内注射英夫利昔单抗。进一步的研究可能会确定哪些患者更适合接受玻璃体腔内注射英夫利昔单抗而非全身治疗。
