Table 2. Case reports of optic neuropathy associated with TNF-α inhibitors: symptoms and examination findings
Case
#
Age/
Gender
Anti-TNF-α Agent
Ocular site Pain Visual Acuity-- Initial
Visual Acuity--Final Visual Field Defect Other studies (FA or VEP)
MRI Follow up (mo)
Reference
1 40M infliximab BA* N
(+ha)
20/40, 20/100 20/20, 20/20 abnormal by CVF NR Y 2 (7)
2 68M infliximab BA N 20/400, 20/60 20/400, 20/40 inferior arcuate OU FA NR, normal
initial VEP
N 5 (8)
3 55M etanercept BA N
(+ha)
20/30, 20/30 20/30+, 20/30 "compatible with optic neuritis"
NR Y 6 (9)
4 21F etanercept BA Y 20/20-2, 20/20-1 20/20, 20/20 normal CVF NR Y 3.5 (10)
5 54M infliximab BA NR 20/30, 20/30 20/30, 20/30 cecocentral capillary dilation;
optic nerve leakage
NR NR (11)
6 62F infliximab BA* NR 20/20, 20/80 20/20, 20/40 cecocentral capillary dilation;
optic nerve leakage
NR NR (11)
7 54M infliximab BA NR 20/400, 20/100 not specified cecocentral capillary dilation;
optic nerve leakage
NR NR (11)
8 42M etanercept then adalimumab
Bilateral but sequential (6wks apart), NR anterior or retrobulbar
NR NR NR NR NR Y 8 (12)
9 21F etanercept BR NR 20/80, 20/80 6/20, 6/24 NR NR NR 6 (13)
10 43M etanercept "papilledema"
(likely BA but unspecified)
NR NR NR NR NR N NR (14)
11 32M infliximab Bilateral unspecified
NR 6/10, 4/10 20/20, 20/20 paracentral, central FA NR, abnormal VEP
Y 6 (15)
12 40F etanercept NR NR NR NR NR NR Y 4 (14)
13 21F etanercept NR NR NR NR NR NR Y 2 (14)
14 41F etanercept NR NR NR NR NR NR Y 1 (14)
15 40M adalimumab UA Y 1/200 20/30 central 0 Y 4 (16)
16 55M infliximab UA* NR 20/200 20/30 NR capillary dilation;
optic nerve leakage
NR 2 (17)
17 45F infliximab UA Y 20/70 20/20 "constricted" NR N 3 (18)
18 12F etanercept UA NR 20/200 20/80 NR NR NR 18 (13)
19 17F etanercept UA NR 20/60 20/30 NR NR NR 20 (13)
20 18M etanercept UA Y 20/80 20/80 NR NR NR 14 (13)
21 60F adalimumab UA* NR 20/25 not specified OD small superior and
OS superior arcuate defect
NR N 1.5 (19)
22 8F etanercept then infliximab
unilateral, no view
NR 20/200 20/40 depressed entire field
but limited study
NR Y 10 (20)
23 53F infliximab Unilateral, NR anterior or retrobulbar
NR amaurosis NR ipsilateral
hemianopsia then amaurosis
NR Y NR (21)
24 61F etanercept Unilateral, NR anterior or retrobulbar
NR NR NR NR NR Y 6 (12)
25 27F infliximab, adalimumab
Unilateral, NR anterior or retrobulbar
Y NR NR NR NR Y 6 (12)
26 32F adalimumab UR Y NR NR NR NR Y 3 (22)
27 76F infliximab UR N 20/150 20/20 generalized
depression
NR Y NR (23)
28 14M etanercept UR N 20/200 20/80 central normal Y 3 (24)
29 55M adalimumab UR N 20/30 20/20 paracentral,
inferotemporal
NR Y 12 (24)
30 55F infliximab UR Y 20/50 20/30 altitudinal--superior NR Y 0.6 (25)
31 44M infliximab UR NR 20/100 20/20 central NR N 1 (26)
32 39F adalimumab UR Y CF CF inferior and central NR Y 3.5 (27)
33 50F infliximab UR Y NR NR superior arcuate,
superior altitudinal
NR Y 1.5 (28)
34 51F infliximab UR Y 20/60 20/20 inferior arcuate NR Y 1 (29)
35 39F infliximab UR Y 20/200 20/40 superior altitudinal NR Y 0.4 (30)
36 31F etanercept then infliximab (also on isoniazid for +PPD)
UR Y 20/20 20/20 unspecified defects normal N 12 (31)
37 45F infliximab UR Y 20/60 20/20 paracentral NR Y 1 (32)
38 62M golimumab BA* N
(+ha)
20/20, 20/50 20/25, 20/400 Inferior altitudinal OU not done N 14 Index patient
*Hemorrhages present.
BA, bilateral optic neuropathy with disc swelling; BR, bilateral retrobulbar optic neuropathy; CVF, confrontational visual field; CF, count fingers; FA, fluorescein angiography; ha, headache; MRI, Magnetic resonance imaging with findings suggestive of demyelinating lesions; N, no; NR, not reported; TNF-a, tumor necrosis factor–alpha; UA, unilateral optic neuropathy with disc swelling;
UR, unilateral retrobulbar optic neuropathy; VEP, visual evoked potential; Y, yes.
