Intravitreal Tumor Necrosis Factor-Alpha Inhibitors for Neovascular Age-Related Macular Degeneration Suboptimally Responsive to Antivascular Endothelial Growth Factor Agents: A Pilot Study from the Pan American Collaborative Retina Study Group

Purpose: To compare the short-term visual and anatomic outcomes after intravitreal injections of 2 different tumor necrosis factor-a inhibitors to continued antivascular endothelial growth factor (VEGF) therapy in eyes with choroidal neovascularization (CNV) secondary to age-related macular degeneration that responded suboptimally to anti-VEGF agents. Methods: Retrospective comparative case series of 26 eyes. Eyes were injected intravitreally with 1 mg infliximab, 2 mg infliximab, 2 mg adalimumab, or 1.25 mg bevacizumab. The main outcomes measured were the best-corrected visual acuity (BCVA) and the central macular thickness (CMT) at 3 months of follow-up. Results: The mean log minimal angle of resolution BCVA changed from 1.04 +/- 0.23 at baseline to 1.06 +/- 0.51 at 3 months (P = 0.9455) in the 1-mg infliximab group; 0.94 +/- 0.48 at baseline to 0.85 +/- 0.43 in the 2-mg infliximab group (P = 0.2802); 1.58 +/- 0.50 at baseline to 1.38 +/- 0.43 in the adalimumab group (P = 0.1116); and 1.08 +/- 0.1 at baseline to 1.03 +/- 0.16 in the bevacizumab group (P = 0.9928). The mean CMT changed from 387 +/- 54 mm at baseline to 342 +/- 108 mm (P = 0.1053) in the 1-mg infliximab group; 301 +/- 42 mm at baseline to 284 +/- 73 mm (P = 0.4854) in the 2-mg infliximab group; remained unchanged at 348 +/- 106 mm (P = 0.308) in the adalimumab group; and 362 +/- 66 mm to 340-27 mm in the bevacizumab group (P = 0.4622). Adverse events included uveitis in 37.5% (6/16) of eyes injected with infliximab. Conclusion: Intravitreal infliximab and adalimumab do not appear to benefit eyes with CNV that responded suboptimally to anti-VEGF agents. Intravitreal injections of infliximab may elicit a severe intraocular inflammatory reaction.