Anti-tumor necrosis factor-alpha therapy for refractory uveitic optic disk neovascularization inactivenon-infectious posterior and panuveitis.

Abstract

Neovascularization of the optic disk (NVD) is mainly a complication of ischemic retinal disorders and of uveitis with vascular occlusion. Rarely, NVD may develop in patients with uveitis in the absence of retinal ischemia. This report aims to present our long-term experience of treating refractory uveitic NVD (uNVD) with adalimumab in three patients with active non-infectious posterior or panuveitis. Observational case series was collected from institutional tertiary referral center. Patients with chronic refractory uNVD who completed 24months of follow-up were included. uNVD was diagnosed on first presentation in all patients (3 eyes). Mean age at presentation was 29years (median 20, range 18-49). Mean duration of complaints before presentation was 18.7weeks (median 24, range 4-28). Uveitis was idiopathic in two patients and secondary to Behçet disease in one. All eyes had concomitant cystoid macular edema. Additional posterior segment signs included optic disk hemorrhage, preretinal hemorrhage and vitreous hemorrhage. All eyes showed retinal vascular leakage and macular leakage with no evidence of capillary non-perfusion. All patients were treated with systemic steroids and steroid-sparing agent. Because of NVD refractoriness, anti-TNF-α therapy was introduced at a mean of 24.7weeks after first presentation (median 20, range 14-40). Complete regression of NVD was observed at a mean of 34.7weeks (median 32, range 8-64) following adalimumab institution. Mean follow-up time after starting anti-TNF-α agents was 31.3months. Our results suggest that targeting TNF-α achieves long-term control of uveitic NVD refractory to conventional treatments.