Acute posterior multifocal placoid pigment epitheliopathy: role of TNF blocker in severe cases.
OBJECTIVE
The aim of this study was to describe cases with severe acute posterior multifocal placoid pigment epitheliopathy treated with tumor necrosis factor (TNF) blocker [Remicade (infliximab)] as regards the improvement of visual acuity, contralateral affection, and prevention of recurrence.


METHODS
We analyzed patients with severe acute posterior multifocal placoid pigment epitheliopathy confirmed by fluorescein fundus angiography as regards the demographic data (age, sex) and the most relevant clinical findings such as, visual acuity, retinal condition, association with other systemic diseases, and response to TNF blocker.


RESULTS
Eight patients were included in this study, 5 (62.5%) of them had unilateral lesion and 3 (37.5%) had bilateral lesions. The mean age of the patients was 29.5 ± 8.5 years (range, 19 to 42 years). Of them, 3 (37.5%) were women and 5 (62.5%) were men. All patients received TNF blocker (Remicade) in 4 doses (infusion of 100 mg), 4 weeks apart. The mean follow-up period was 23.6 ± 9.9 months (range, 8-36 months). During this period, no recurrence occurred with control of the associated systemic disease. There was a statistically significant improvement of the visual acuity from 0.49 ± 0.36 to 0.69 ± 0.21 (P < 0.05). Among patients with unilateral lesion, three developed contralateral affection. Adverse effects from Remicade did not occur.


CONCLUSIONS
The TNF blocker can be used in patients with severe acute posterior multifocal placoid pigment epitheliopathy with no recurrence rate. However, it does not prevent the contralateral affection. Another prospective study with a control group and longer follow-up time is needed to confirm these results and to evaluate the effect of TNF blocker on final visual acuity.
Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. telragal@hotmail.com
Hussein S
HS
El-Markaby
Thanaa H
TH
Mohammed
Tamer M
TM
El-Raggal
D000208:Acute Disease; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D000069285:Infliximab; D008297:Male; D010857:Pigment Epithelium of Eye / Q000187:drug effects* / Q000473:pathology; D012164:Retinal Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D055502:Secondary Prevention; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab