Intravitreal infliximab for refractory pseudophakic cystoid macular edema: results of the Pan-American Collaborative Retina Study Group

Abstract

Inflammation is the major etiologic factor in the development of pseudophakic cystoid macular edema (CME). Several soluble mediators of inflammation such as tumor necrosis factor alpha (TNF-α) have been implicated in the pathogenesis of ocular inflammation. The purpose of this study is to report the short-term visual and anatomic outcomes following intravitreal injections of infliximab in eyes with refractory CME secondary to cataract surgery. An interventional, retrospective study of 7 eyes with refractory CME that were injected with 1 mg of infliximab. The main outcome measures were best-corrected visual acuity (BCVA) and central macular thickness (CMT) at 6-month follow-up. At the 6 month follow-up, BCVA improved from 1.14 ± 0.59 logMAR at baseline to 0.51 ± 0.35 logMAR (p = 0.0156). CMT also improved from 584 ± 159 μm at baseline to 327 ± 127 μm at 6 months (p = 0.0111). No systemic adverse events were reported in these patients. There was a single episode of uveitis that responded to topical steroids. Inhibition of TNF-α may be beneficial in the treatment of refractory pseudophakic CME.

Effectiveness and safety of dexamethasone implants for postsurgical macular oedema including Irvine–Gass syndrome: the EPISODIC-2 study

“…Infliximab is an anti-TNFα with immune-suppressive properties. A case series has suggested its effectiveness when administered by intravitreal injection to seven eyes with IG syndrome after the failure of intravitreal injection of anti-VEGF,24 with a mean increase in BCVA from 1.14±0.59 logMAR to 0.51±0.35 logMAR (p=0.0156) after 6 months’ follow-up. However, adverse effects were also reported, in particular, retinotoxicity 25.…”

Effectiveness and safety of dexamethasone implants for post-surgical macular oedema including Irvine-Gass syndrome: the EPISODIC study

“…A case series has suggested its effectiveness when administered by intravitreal injection to seven eyes with IG syndrome after the failure of intravitreal injection of anti-VEGF 22. Indeed, after an average of 2.7 intravitreal injections, mean BCVA increased from 1.14±0.59 logMAR to 0.51±0.35 logMAR (p=0.0156) after 6 months’ follow-up.…”

Intravitreal dexamethasone implant for recurrent cystoid macular edema due to Irvine–Gass syndrome: a prospective case series

“…The sample size is probably too small to find out any adverse effects such as endophthalmitis, retinal detachment, and vitreous hemorrhage. It deals with an important problem and one that can be frustrating for the cataract surgeon who might feel robbed of success after a perfectly executed cataract (mm Hg) 14.4 ± 4.32 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) 16.4 ± 4.4 14.8 ± 5 13.54 ± 4.2 P = 0.56 P = 0.48 P = 0.6…”

“…10 A certain subset of patients, however, does not respond to topical therapy alone. A step ladder approach for the management of these patients is proposed and includes oral carbonic anhydrase inhibitor therapy, 11 peribulbar 12 or intravitreal steroids, 13 anti-VEGF agents, 14 immunomodulators 15,16 and, in cases secondary to vitreous traction, Nd: Yag laser vitreolysis, 17 vitrectomy, 18 or other surgical approaches. There is, however, no standardized protocol prescribed for its management, probably because of a lack of randomized trials.…”