Infliximab in the treatment of refractory posterior uveitis

Purpose: To determine the efficacy and safety of infliximab in the treatment of refractory posterior uveitis. Design: Noncomparative interventional case series. Participants: Five patients with posterior uveitis were treated: 3 had Behget's syndrome, and 2 had idiopathic posterior uveitis. Interventions: Patients with sight-threatening uveitis refractory to other immunosuppressive agents were treated with infliximab. Main Outcome Measures: Intraocular inflammation, by using binocular indirect ophthalmoscopy score, retinal vasculitis, and visual acuity. Adverse effects of infliximab were documented. Results: Within 2 weeks of the first infusion of infliximab, 4 of 5 patients showed marked improvement in vitreous haze and visual acuity. By the 6-month follow-up, the same four patients had achieved remission of posterior uveitis and had successfully withdrawn all other immunosuppressive therapy. Further infusions of infliximab were required in 3 patients. One patient developed ocular and systemic tuberculosis, which responded to antituberculous treatment. Conclusions: Infliximab is effective in the treatment of sight-threatening refractory posterior uveitis. However, patients should be thoroughly screened for tuberculosis before treatment and followed up closely during and after therapy with infliximab. (C) 2003 by the American Academy of Ophthalmology.