Efficacy of infliximab therapy in the treatment of idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome

PURPOSE: To evaluate the efficacy of infliximab therapy in patients with idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome and to describe clinical and anatomical outcomes following treatment. METHODS: This case series involved the prospective evaluation of three patients diagnosed with IRVAN syndrome who received systemic infliximab therapy and underwent longitudinal multimodal imaging follow-up. All patients completed a comprehensive systemic, infectious, and autoimmune workup to exclude secondary causes of vasculitis. Primary outcome measures included clinical response, changes in best-corrected visual acuity (BCVA), evolution of imaging findings, and treatment tolerability. RESULTS: Three patients (2 females, 1 male) with a mean age of 32.3 years [range 17-51] were included in the study. The mean interval from initial diagnosis to the initiation of infliximab therapy was 33.7 months (range 5-66), with a mean post-treatment follow-up of 14 months (range 6-24). All patients exhibited a favorable therapeutic response, characterized by the regression of retinal and optic nerve head aneurysms, resolution of vascular leakage, and resorption of macular exudates. BCVA remained stable or improved in all cases. Infliximab was well-tolerated, with no serious systemic adverse events recorded during the study period. CONCLUSION: In this series, infliximab induced sustained anatomical and functional stabilization. These findings suggest that administration early in the course of the disease may optimize long-term outcomes and mitigate the risk of irreversible vision loss associated with progressive IRVAN syndrome.