The Effect of Infliximab Therapy on Maculopathy in Behcet's Panuveitis: A Case Report

Abstract

Aim: To report a case of Behcet's panuveitis and unilateral inflammatory maculopathy which was refractory to conventional immunosuppressive therapy but responded well to long-term treatment with the tumor necrosis factor-alpha inhibitor infliximab.

Methods: Reporting the effect of intravenous infliximab infusion therapy for 54 weeks in a case of Behcet's panuveitis and unilateral inflammatory maculopathy. The patient's best corrected visual acuity was monitored, and biomicroscopic and fundus examinations as well as macular thickness map analysis by stratus optical coherence tomography were performed.

Results: The best corrected visual acuity in his right eye improved after the resolution of inflammatory signs on biomicroscopic and fundus examinations as well as on stratus optical coherence tomography macular thickness analysis reports. No significant systemic side effects were noted.

Conclusions: Long-term therapy with infliximab is effective and safe for refractory inflammatory maculopathy in Behcet's disease. We report this case to contribute to the few previously reported cases showing the beneficial effect of long-term infliximab therapy for Behcet's panuveitis. In conclusion, early initiation of infliximab therapy for inflammatory maculopathy in Behcet's disease preserves and improves visual acuity.

Keywords: Behcet's panuveitis; Inflammatory maculopathy; Infliximab therapy; Visual acuity.

Fig. 1

Baseline color fundus photograph of the right eye showing blunted macular reflex and RPE irregularities and mottling.

Fig. 2

Baseline OCT3 of the right macula. Note the thinning of the retinal and RPE layers.

Fig. 3

Left: baseline right macular thickness map by OCT3. Note the thinning in the central 1-mm zone with a foveal thickness of 107 ± 11 µm, and associated with a thinning in the 3–6-mm zone with a total macular volume of 6.48 mm³. Right: baseline left macular thickness map by OCT3 showing a foveal thickness of 171 ± 4 µm and a total macular volume of 7.84 mm³.

Fig. 4

Left: right macular thickness map by OCT3 at 22 weeks of infliximab therapy, demonstrating an increase in thickness in the central 1-mm zone with a foveal thickness of 206 ± 24 µm associated with thinning in the 3–6-mm zone with a total macular volume of 6.31 mm³. Right: left macular thickness map by OCT3 at 22 weeks of infliximab therapy, showing that the left foveal thickness was 177 ± 6 µm, and the left total macular volume was 7.8 mm³.

Fig. 5

Color fundus photograph of the right eye at 54 weeks of infliximab therapy. Note the reduction of RPE irregularities and mottling in the macular area.

Fig. 6

Macular thickness change analysis report by OCT3 comparing the macular thickness of the right and the left eye at baseline and at week 54. Note the increased thickness in the 1–3-mm zone and the reduced thickness in the 3–6-mm zone of the right macular region. No significant changes were found in the analysis of the left macular thickness report.