Intravitreal Administration of the Anti-Tumor Necrosis Factor Agent Infliximab for Neovascular Age-related Macular Degeneration

PURPOSE: To present our preliminary experience on intravitreal administration of an anti-tumor necrosis factor (TNF) monoclonal antibody for neovascular age-related macular degeneration (AMD). DESIGN: Prospective, noncomparative series of 3 patients previously treated with an anti-vascular endothelial growth factor agent. METHODS: Two intravitreal injections of 0.05 ml containing infliximab were administered in the first (1 and 2 mg, 2 months apart), second (2 mg each, 2 months apart), and third patient (2 mg each, 3 months apart). Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were monthly assessed for up to 7 months. RESULTS: In the first patient, BCVA increased from 20/200 to 20/100 and CFT decreased from 462 to 386 mu m, 2 months after the first injection. The condition was further improved after the second injection (BCVA, 20/40; CFT, 210 mu m), but recurrence occurred 7 months post-baseline. In the second patient, BCVA increased from 20/200 to 20/70 and CFT decreased from 512 to 420 and 184 mu m, 2 and 4 months post-baseline, respectively. In the third patient, clinical improvement was documented after the first injection. A second injection attributable to recurrence resulted in improvement of BCVA from 20/100 to 20/30 and decrease of CFT from 388 to 282 mu m, 2 months after the second injection. CONCLUSIONS: These findings, although insufficient to consider "off-label" treatment with intravitreal infliximab, provide in vivo evidence of a pathogenetic link of locally produced and/or acting TNF to neovascular AMD. A randomized Study of consecutive intravitreal injections of infliximab for AMD may be warranted. (Am J Ophthalmol 2009;147:825-830. (c) 2009 by Elsevier Inc. All rights reserved.)