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Anti-tumor necrosis factor-alpha therapy for refractory uveitic optic disk neovascularization in active non-infectious posterior and panuveitis

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Abstract

Purpose

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.

Methods

Observational case series was collected from institutional tertiary referral center. Patients with chronic refractory uNVD who completed 24 months of follow-up were included.

Results

uNVD was diagnosed on first presentation in all patients (3 eyes). Mean age at presentation was 29 years (median 20, range 18–49). Mean duration of complaints before presentation was 18.7 weeks (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 24.7 weeks after first presentation (median 20, range 14–40). Complete regression of NVD was observed at a mean of 34.7 weeks (median 32, range 8–64) following adalimumab institution. Mean follow-up time after starting anti-TNF-α agents was 31.3 months.

Conclusions

Our results suggest that targeting TNF-α achieves long-term control of uveitic NVD refractory to conventional treatments.

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Authors and Affiliations

  1. Department of Ophthalmology, Hadassah Medical Center, POB 12000, 91120, Jerusalem, Israel

    Radgonde Amer & Oren Cohen

  2. Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Radgonde Amer

Authors
  1. Radgonde Amer
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  2. Oren Cohen
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by all authors. The first draft of the manuscript was written by all authors. All authors read and approved the final manuscript.

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Correspondence to Radgonde Amer.

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Conflict of interest

Oren Cohen: Not applicable. Radgonde Amer: lecturer, AbbVie.

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Amer, R., Cohen, O. Anti-tumor necrosis factor-alpha therapy for refractory uveitic optic disk neovascularization in active non-infectious posterior and panuveitis. Int Ophthalmol 41, 3523–3531 (2021). https://doi.org/10.1007/s10792-021-01919-6

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