Anti-Tumor Necrosis Factor Alpha for Retinal Diseases: Current Knowledge and Future Concepts

Tumor necrosis factor (tnf) alpha is a pro-inflammatory cytokine produced by macrophages and t-cells. it plays an important role both in inflammation and apoptosis. in the eye, tnf alpha appears to have a role in the pathogenesis of inflammatory, edematous, neovascular and neurodegenerative disorders. several tnf-blocking drugs have been developed and approved, and are in clinical use for inflammatory diseases such as rheumatoid arthritis, psoriasis and ankylosing spondylitis. tnf alpha blockers are widely used in ophthalmology as an off-label alternative to traditional immunosuppressive and immune-modulatory treatments in noninfectious uveitis. preliminary studies suggest a positive effect of intravenously administered tnf alpha blockers, mainly infliximab, for treating refractory diabetic macular edema and neovascular age-related macular degeneration. unfortunately, much of the current data raises considerable safety concerns for intravitreal use of tnf alpha inhibitors, in particular, intraocular inflammatory responses have been reported after intravitreal injection of infliximab. results of dose-finding studies and humanized antibody or antibody fragments (e.g. adalimumab) are anticipated in the coming years; these will shed light on potential benefits and risks of local and systemic tnf alpha blockers used for treatment of diseases of the retina and choroid