Journal of Ophthalmology & Clinical Research Category: Clinical Type: Case Report
Successful Treatment of Behcet’s Eye Disease with Infliximab Therapy
- Deepak Bhojwani1*, Jyotirmay Biswas2
- 1 Vitreo Retina Consulatant, Ahmedabad, India
- 2 Director Of Uveitis And Ophthalmic Pathology, Sankara Nethralaya, Chennai, India
*Corresponding Author:Deepak Bhojwani
Vitreo Retina Consulatant, Ahmedabad, India
Received Date: Jan 06, 2015 Accepted Date: Jan 28, 2015 Published Date: Feb 11, 2015
We describe our experience with infliximab therapy in Behcet’s disease in our below case report of a 15 year old boy treated at our institute.
Figure 1: Posterior pole colour fundus photograph of both eyes. Note prominent Vitreous Haze (+2) evident in left eye.
Figure 3: Spectral domain OCT documenting normal foveal architecture in right eye. Central foveal thickness OD-163 microns, and mild retinal thickening of 172 microns in left eye.
On second month follow-up examination, the visual acuity improved in both eyes to 20/20. Inflammation was controlled in both eyes. The patient did not experience any reoccurrence of gastrointestinal illness or oral ulcers. However his intraocular pressure was high in both eyes (OD-30 mm Hg; OS- 38 mm Hg). Steroid response was suspected as the cause for it and the patient was prescribed antiglaucoma medications (oral acetazolamide along with dorzolamide and combigan eye drops in both eyes). We tapered down and stopped systemic steroids. Cyclosporine immunosuppressive therapy with renal function monitoring was continued.
At 6 month follow-up examination, IOP in his left eye was 22 mm Hg (still on higher side) and vitreous haze was also persisting, and so we adviced biological immunomodulator therapy with infliximab for this patient. He received infliximab infusion 5 mg/kg on day 1, second week, sixth week and thereafter every sixth week till 6 months.
After starting systemic infliximab injections, we noted marked resolution of vitreous haze and the inflammation in both eyes has been under control. On his recent visit, visual acuity in both eyes was 20/20. IOP was 14 mm Hg in right eye and 16 mm Hg in left eye on topical anti-glaucoma medications. Anterior segment examination of both eyes was unremarkable. Sheathing of vessels was noted on fundus examination in both eyes (Figure 4). We have followed up this patient for 1 year post infliximab therapy and there has been no recurrence of ocular or systemic disease.
Among anti-TNF agents, infliximab and etanercept have been used in the treatment of Behçet’s disease. The biggest study on interferon treatment in Behcet’s disease showing the beneficial effect of interferon on eye disease was done by Demiroglu et al. Although some controversy arose previously, it was later proved that there were no ethical transgressions it that study and it was unequivocally shown that interferon alpha prevents ocular involvement in Behcet’s disease [9-11]. Currently clinicians prefer Infliximab therapy over etanercept for treating Behcet’s disease to avoid recurrence of the disease . Data continues to accumulate suggesting infliximab administration leads to rapid and effective suppression of all Behçet’s disease manifestations.[13,14,15] In our case infliximab therapy successfully suppressed the Behcet’s eye disease during our 1 year treatment evaluation. Long term treatment outcomes with infliximab therapy are awaited. Interestingly, it also suppressed recurrence of gastrointestinal illness, oral and genital ulcerations in our case. The major constraint in starting infliximab therapy for Behcet’s patients is the financial burden of treatment on patient especially in our country. Drug-induced lupus has been reported a major adverse side effect with TNF- alpha blocking therapies, including infliximab. Other rare but life threatening events reported with these therapies include infections, malignancy, heart failure, demyelinating disease [16,17]. Our patient did not suffer from any major systemic side effect during his short term infusion therapy with infliximab. We recommend monitoring of vital signs, liver function tests, tuberculin skin tests, ANA (Antinuclear Antibodies) and hemogram as a standard protocol for every patient taking TNF-alpha therapy. To our knowledge, there has not been any previously documented case report on treatment of Behcet’s eye disease with Infliximab therapy from India. And so we present the following case to document regression of Behcet’s eye disease with infliximab therapy.
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Citation:Deepak B, Jyotirmay B (2015) Successful Treatment of Behcet’s Eye Disease with Infliximab Therapy. J Ophthalmic Clin Res 2: 006.
Copyright: © 2015 Deepak Bhojwani, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.