Intravitreal İnfliximab İnjeksiyonun Retinal Toksitesinin Değerlendirilmesi

Amaç : Tavşanlarda farklı dozlardaki intravitreal inflixamab injeksiyonun toksitesinin değerlendirilmesi. İnfliximab romatoid artrit ve crohn hastalığı için FDA onaylı anti enflamatuar bir ilaçtır. Kronik dirençli üveitlerde özellikle behçet hastalığı, diyabetik retinopati ve PVR için alternatif veya yardımcı ilaç olabileceğini gösteren yayınlar bildirilmiştir. Bulgular ve Gereçler : 20 beyaz Yeni Zelanda tavşanları 5 gruba (n=4) ayrılarak bu çalışmada kullanılmıştır. Hayvanlara uygulamalarda ARVO yönergeleri izlenmiştir. Tavşanların bir gözüne intravitreal olarak 0.125 mg , 0.250 mg, 0.500 mg, 1.25 mg ve 2.5 mg inflixmab 0.1 tuzlu solüsyon içinde , diğer kontrol gözüne ise 0.1 tuzlu solüsyon olarak uygulanmıştır. Tüm hayvanlar deneyden önce muayenesi ve deneyden sonraki 1., 7., ve 14. günde indirek oftalmoskopi ve yarık lamba biyomikroskopi muayeneleri yapılmıştır. ERG deneyden önce ve sonraki 14. günde yapılmıştır. Hayvanlara 14. günde ötonazi uygulanmıştır. Enükleasyon edilen gözlerin histolojik örnekleri retina toksidi açısından incelenmiştir. BULGU : Biz 1.25 mg doza kadar olan grupta ERG ve histolojik olarak bir toksite bulmadık. 2.5 mg grubun 4 gözünden birinde ERG'sinde anlamlı azalma ve histoojik toksite bulguları saptadık. SONUÇ : 1.5 mg doza kadar olan inflixmab injeksiyonu tavşan retinasında non toksiktir. İntravitreal inflixmab injeksiyonu üveitlerde özellikle de behçet hastalığında diyabetik retinopatide yaşa bağlı makula dejenerasyonunda ve proliratif vitreo retinopatide yararlı bir tedavi olabilir.

Anahtar Kelimeler:

infliximab, retinal toksite, üveit, behçet hastalığı, diyabetik retinopati

The Evaluation Retinal Toxicity of Intravitreal Infliximab Injection

Objective To evaluate toxicity of varying doses of Infliximab injecting intravitreally in rabbits. Infliximab, an FDA approved anti-inflammatory drug for Rheumatoid arthritis and Crohn’s disease. It has been reported as an alternative or adjunct drug to chronic recurrent uveitis especially Behcet’s disease, Diabetic retinopathy and PVR Materials and Methods Twenty New Zeland albino rabbits were used for this study and divided into five groups (n=4 each). ARVO guidelines were followed in treatment of animals. The rabbits were injected intravitreally with, 0.125mg 0.250mg, 0.500mg, 1.25mg or 2.5mg Infliximab in 0.1 ml in one eye and 0.1 ml saline solution was used in the contralateral eye. All the animals were examined using indirect ophthalmoscopy and slit-lamp biomicroscopic examination before intravitreal injection and at days 1,7 and 14. An ERG was performed before any treatment and at day 14. On day 14 the animals were euthanized. Histological preparations of the enucleated eyes were examined for retinal toxicity. Results We found no retinal toxicity up to 1.25mg groups according to ERG results and Histological signs. 1of 4 eyes in the 2.5mg group had some significant decrease in Electroretinogram and histological toxicity signs. Conclusions Infliximab injection up to 1.25 mg is nontoxic to the rabbit’s retina. Intravitreal injected Infliximab may be a useful treatment for Uveitis especially Behcet’s disease, Diabetic retinopathy, Age Related Macular Degeneration and Proliferative Vitreoretinopathy.

Keywords:

infliximab retinal toxicity, intravitreal injection, uveitis, behcet’s, diabetic retinopathy,

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