Klin Monbl Augenheilkd 2011; 228(4): 362-363
DOI: 10.1055/s-0031-1273263
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© Georg Thieme Verlag KG Stuttgart · New York

Efficacy of Infliximab Therapy in Two Patients with Sympathetic Ophthalmia

Nutzen von Infliximab in zwei Patienten mit sympathischer OphthalmieM. Menghini, S. A. F. Frimmel, R. Windisch, F. M. Meier
Further Information

Publication History





Publication Date:
11 April 2011 (online)

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

  • 1 Damico F M, Kiss S, Young L H. Sympathetic ophthalmia.  Semin Ophthalmol. 2005;  20 191-197
  • 2 Castiblanco C P, Adelman R A. Sympathetic ophthalmia.  Graefes Arch Clin Exp Ophthalmol. 2009;  247 289-302
  • 3 Rao N A. Sympathetic ophthalmia. In: Ryan S J, (ed) Retina,. 3 rd edn. Mosby: New York; 2001. 3 rd edn.: 1756-1761
  • 4 Theodossiadis P G, Markomichelakis N N, Sfikakis P P. Tumor necrosis factor antagonists: preliminary evidence for an emerging approach in the treatment of ocular inflammation.  Retina. 2007;  27 399-413
  • 5 Giganti M, Beer P M, Lemanski N et al. Adverse events after intravitreal infliximab (Remicade).  Retina. 2010;  30 71-80

Dr. Moreno Menghini

Department of Ophthalmology, University Hospital of Zurich

Frauenklinikstr. 24

8091 Zurich

Switzerland

Email: Moreno@menghini.biz