patients with behet 's disease often need intraocular surgeries for the treatment of secondary cataract or glaucoma . this study aims to report the clinical course before and after the intraocular surgeries of 5 patients who were systematically treated with infliximab .
seven eyes of 5 male patients with behet 's disease , who underwent intraocular surgery while under systemic infliximab therapy at yokohama city university hospital from 2007 to 2009 , were included in the study .
phacoemulsification was performed on 4 eyes , and trabeculectomy was done on the remaining 3 eyes .
control of the ocular attacks with the use of other systemic medications was difficult for all patients ; however , the use of infliximab enabled adequate control of the attacks .
the visual acuity status during the preoperative stage did not worsen during the postoperative period .
patients with behet 's disease in need of intraocular surgery can benefit from control of attacks with infliximab treatment .
behet 's disease ( bd ) is characteristically an incurable systemic disease with recurrent inflammation [ 1 , 2 , 3 ] . in japan , bd is known as one of the three major causes of uveitis . in general ,
uveitis is frequently associated with complicated cataract and secondary glaucoma [ 4 , 5 ] . in some cases ,
when surgical treatment of ocular inflammatory diseases is considered , control of the ocular inflammation before and after surgery is an important factor [ 4 , 5 ] .
for an ideal outcome of surgical treatment it is necessary that ocular inflammation has been under control for a few months prior to surgery .
since the attacks of bd tend to be induced by surgical invasion , the decision to conduct surgery for bd is meticulous compared to other uveitis .
however , there are cases of bd with uncontrollable uveitis , and such cases occasionally need surgical treatment .
infliximab is a monoclonal antibody against tumor necrosis factor - a ( tnf - a ) .
infliximab has been approved for treatment of incurable bd uveoretinitis in japan since 2007 , and definite promising effects have been noticed . on the other hand , the drug can possibly induce infectious complications of surgical treatment because of the systemic suppression of tnf - a [ 1 , 2 , 6 , 7 , 8 ] .
this study presents 5 cases of bd with cataract and glaucoma surgeries under infliximab treatment .
seven eyes of 5 patients with bd , who underwent intraocular surgery while under systemic infliximab therapy at yokohama city university hospital from 2007 to 2009 , were included in the study .
all patients were men , and the mean age at the time of surgery was 44.2 ( 30 - 70 ) years .
four eyes underwent phacoemulsification , while trabeculectomy was performed on the remaining 3 eyes . the mean duration since the onset of ocular symptoms was 110 ( 34 - 180 months ) .
before infliximab was administered , all patients were systemically given colchicine , cyclosporine , and other immunosuppressive agents .
however , control of the ocular attacks was difficult with the medicine administered , and the patients frequently experienced active ocular attacks .
infliximab therapy was administered at 5 mg / kg at 0 , 2 , and 6 weeks ; after that , the infusion was administered every 8 weeks , except for patients b and e. minor ocular attacks still occurred ; thus , the infusion interval was decreased to every 6 weeks , which resulted in control of attacks . during the postoperative period , ocular attacks were observed in patients a and b ; however , every attack was controlled with temporary medicines .
ever since infliximab has been available for the treatment of bd , its excellent efficacy against ocular attacks of bd has been reported [ 1 , 2 , 3 , 6 ] . however , in cases where surgical treatment is considered , it is possible that infliximab might induce infections during the perioperative period because it suppresses cytokines for improved postoperative wound healing [ 1 , 2 , 7 ] .
surgical treatment of rheumatoid arthritis under infliximab therapy is recommended to be performed 4 weeks after infliximab infusion in order to assure a minimum systemic concentration of infliximab [ 1 , 2 , 7 ] .
previously , some patients with bd who underwent cataract surgery under systemic infliximab treatment were reported in japan [ 1 , 2 ] . the reports followed the rheumatic guidelines , and no remarkable complications were described in any cases .
in the field of orthopedic surgery , it was previously reported that infliximab did not increase the risk of either infections or surgical complications occurring in patients with rheumatoid arthritis within 1 year of orthopedic surgery .
furthermore , in the same field , previously reported complications were localized infections , and infliximab is considered to be relatively safer than the other anti - tnf - a drugs in the perioperative period . in our search of the literature
, we could not find any report of a correlation between endophthalmitis or toxic anterior segment syndrome ( tass ) and systemic immunosuppressive treatment .
the localized infection - like wound complications could be a concern in the field of orthopedic surgery as well as ophthalmology . in our study
perioperative infection was more frequent among the glaucoma than cataract cases in the previous report .
ocular inflammation after surgery could be controlled with medicine as well . based on our limited sampling of infliximab - treated patients with bd
, infliximab has the potential not to complicate any subsequent surgery , not only for cataract but also for glaucoma . to reach a clearer conclusion ,
a greater number of subjects is necessary as well as a comparison with cases without infliximab treatment .
although further investigation is needed , we suggest a possible efficacy of infliximab in intraocular surgeries of bd .
 purposepatients with behet 's disease often need intraocular surgeries for the treatment of secondary cataract or glaucoma . this study aims to report the clinical course before and after the intraocular surgeries of 5 patients who were systematically treated with infliximab.methodsretrospective case series.resultsseven eyes of 5 male patients with behet 's disease , who underwent intraocular surgery while under systemic infliximab therapy at yokohama city university hospital from 2007 to 2009 , were included in the study . 
 the mean age at surgery was 44.2 years . 
 phacoemulsification was performed on 4 eyes , and trabeculectomy was done on the remaining 3 eyes . 
 the mean duration since the onset of the ocular symptoms was 107 months . 
 control of the ocular attacks with the use of other systemic medications was difficult for all patients ; however , the use of infliximab enabled adequate control of the attacks . 
 the visual acuity status during the preoperative stage did not worsen during the postoperative period . 
 no infectious complication was observed in all cases.conclusionsour results suggest that infliximab treatment does not complicate any subsequent intraocular surgery . 
 patients with behet 's disease in need of intraocular surgery can benefit from control of attacks with infliximab treatment . 
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