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DOI: 10.1055/s-0031-1273263
© 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 OphthalmiePublication 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