Adalimumab Therapy as a Rescue Treatment Option in Refractory Acute Sympathetic Ophthalmia: Case Series and Review of...

To report the efficacy of adalimumab (ADA) in controlling inflammation and salvaging vision in a series of patients with sympathetic ophthalmia (SO) refractory to conventional maximal medical therapy with systemic steroids and immunomodulatory treatment (IMT) or with contraindications to steroid therapy, with a focus on its novel application in acute refractory cases of SO.

Retrospective chart review of three patients with acute SO and exudative retinal detachment (ExRD), refractory to corticosteroids and IMT or with contraindication to steroids, termed refractory SO. All patients received ADA 40 mg subcutaneously every 2 weeks under rheumatologist supervision. Clinical response was closely monitored using multimodal imaging.

All three patients had acute active SO with ExRD. Two patients had persistent inflammation despite intravenous methylprednisolone (IVMP) or high dose oral steroids; the third could not be given systemic steroids due to uncontrolled diabetes. Following ADA initiation, all showed rapid resolution of inflammation and subretinal fluid (SRF) with reduction in the subfoveal choroidal thickness (SFCT) and improvement in best corrected visual acuity (BCVA). This allowed successful tapering of systemic steroids while maintaining inflammatory control at final follow-up.

We report a case series of three patients with SO refractory to pulse steroids and IMT, which showed rapid anatomical and functional improvement with ADA. ADA is highly efficacious in acute refractory SO, resulting in prompt resolution of active inflammation and maintenance of remission. This case series adds to the limited existing evidence on the role of TNF-α inhibitors in managing this rare but sight-threatening condition.