Efficacy of Infliximab Therapy in Two Patients with Sympathetic Ophthalmia

Background

Sympathetic ophthalmia (SO) is a rare bilateral granulomatous uveitis that can occur after a severe, mostly penetrating injury to one eye [1]. Typical characteristics are thought to be Dalen-Fuchs nodules, which are composed of epitheloid cells and histiocytes at the level of the retinal pigment epithelium [2]. Its pathophysiology involves an autoimmune process after disrupting the immunological privilege of the eye [2]. Genetic susceptibility has been proven for HLA-A11 and HLA-DR4 antigens [3].

There is no standardized regimen, but local and systemic corticosteroids are mostly used as first line drugs. Enucleation of the inciting eye is a surgical option if the eye is blind or severely traumatized, but its effect is still being controversially discussed [2]. Newly immunomodulatory drugs have been used due to the known side effects of long-term systemic corticosteroid therapy. Being considered a first line immunomodulatory therapy in addition to corticosteroid is cyclosporine. Additional successfully used drugs are methotrexate, cyclophosphamide, azathioprine, mycophenolate, chlorambucil and tumor necrosis factor (TNF) blockers. Anti-Tumor necrosis factor alpha (anti-TNFα) agents (etanercept, infliximab, adalinumab) have been increasingly used in refractory uveitis [4]. Infliximab (Remicade®, Essex Chemie AG, Lucerne, Switzerland) is a monoclonal IgG1 antibody to TNFα [5]. The aim of the present case series is to describe two patients with SO and administration of infliximab.

References

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