Objective To evaluate anatomical and functional outcomes following a switch to intravitreal faricimab in patients with active, recalcitrant neovascular age-related macular degeneration (nAMD) previously treated with aflibercept in a real-life setting. Design A retrospective, observational, single-centre study. Methods Demographic data and prior intravitreal treatment (IVT) history were collected. Best-corrected visual acuity (BCVA) and disease activity were assessed using optical coherence tomography (OCT), including fluid compartments: intraretinal fluid, subretinal fluid (SRF), pigment epithelial detachment, and subretinal hyperreflective material. Results A total of 161 eyes from 145 patients (mean age: 80.1 ± 7.8 years) were included. Mean prior IVT duration was 2.9 ± 2.5 years. All eyes were active at the time of switching, with 82.0% showing persistent SRF. Disease inactivation occurred in 42.9% of eyes after the switch, more frequently in eyes with shorter prior treatment duration. BCVA remained stable throughout the follow-up. SRF resolved in 50.8% of eyes, with 52.2% achieving resolution after a single injection. Mean treatment intervals increased significantly in inactivated eyes (+4.9 ± 5 weeks). Disease relapse occurred in 54.6% of the initially inactivated eyes. No adverse events were reported. Conclusions Switching to faricimab may offer a valuable therapeutic option for recalcitrant nAMD, particularly in eyes with persistent SRF, providing improved anatomical outcomes while maintaining visual acuity in real-life practice. Prospective studies are warranted to better define response profiles and guide personalized treatment strategies.

Ocular toxoplasmosis is the most common cause of posterior uveitis worldwide and a major cause of visual impairment. Previous studies suggest that the disease may follow a more aggressive clinical course in patients from Latin America; however, direct comparative evidence between geographic populations remains limited. This study aimed to characterize the clinical, serological, and imaging features of a multiethnic cohort of patients with ocular toxoplasmosis and to assess differences according to geographic origin. A retrospective chart review was performed including 144 patients diagnosed with ocular toxoplasmosis at a tertiary referral center in Barcelona, Spain. Clinical characteristics, recurrence patterns, visual outcomes, and serological findings were analyzed. Outcomes were compared between Latin American (n = 73) and European (n = 71) patients. Latin American origin (OR 8.21; p < 0.001) and older age at disease onset (OR 1.04; p = 0.009) were independently associated with atypical disease presentation. Latin American origin (β = +0.20 LogMAR; p = 0.02), congenital disease (β = +0.52 LogMAR; p < 0.001), and retinal zone I involvement (β = +0.57 LogMAR; p < 0.001) were independently associated with worse visual acuity outcomes. Latin American origin (OR 4.85; p = 0.002) and longer time since disease onset (OR 1.05; p = 0.04) were independently associated with multiple recurrences, whereas congenital disease (OR 0.03; p = 0.01) was associated with lower recurrence risk. Serum IgG levels were significantly higher in Latin American patients (p = 0.002), who also more frequently required systemic corticosteroids along with antiparasitic treatment. Patients of Latin American origin showed a higher prevalence of atypical disease, increased recurrence rates, and poorer visual outcomes compared with European patients. These findings support the hypothesis of a more severe disease phenotype in this population and highlight the importance of closer monitoring and individualized management strategies in patients at higher risk of severe ocular toxoplasmosis.

Age-related macular degeneration (AMD), a chronic inflammatory disease, is a major cause of irreversible blindness worldwide. It involves the degeneration of the retinal pigment epithelium (RPE) and the accumulation of deposits between the RPE and the Bruch's membrane (BrM), ultimately leading to photoreceptor death. The multifactorial and chronic nature of AMD makes it challenging to model in vitro. We developed a biomaterial based on decellularized BrM (dECM-BrM) from aged donors to evaluate its ability to induce an AMD-like phenotype in RPE monolayers. BrM from 5 young and 5 aged human donors was decellularized and the protein profile analyzed by LC-MS/MS. dECM-BrM was then used as a coating substrate for RPE culture. A total of 281 proteins were identified and proteomic analysis screened 49 differentially expressed proteins in aged dECM-BrM. Gene Ontology analysis showed that they were associated with extracellular region, antioxidant activity, lipid metabolism and transport. Moreover, the KEGG pathway related to complement and coagulation cascade was significantly enriched. RPE culture on aged dECM-BrM allowed RPE polarization and after 60 days, transepithelial electrical resistance significantly decreased compared to RPE grown on young dECM-BrM, accompanied by increased IL-33 secretion and marked expression of drusen components such as vitronectin and apolipoprotein E, lipid deposition and complement factors C3 and C9. We showed a successful approach to obtain a BrM mimic based on decellularized BrM that ensured cellular removal while preserving ECM structure and identified differentially expressed proteins in aged dECM-BrM that may provide specific biochemical cues fundamental to model AMD in vitro.

To evaluate the feasibility and potential clinical utility of ultra-widefield (UWF) retinal imaging as a screening strategy for the early detection of asymptomatic cytomegalovirus retinitis (CMVR) in patients with systemic cytomegalovirus (CMV) viremia after allogeneic hematopoietic stem cell transplantation (alloHSCT). This prospective, single-center pilot study included adult alloHSCT recipients with documented CMV replication within the previous 12 months and no ocular symptoms. Patients underwent UWF retinal imaging (Optomap®) at the time of CMV detection and during follow-up. Demographic, hematologic, immunologic, and virologic data were collected. Retinal images were assessed by a uveitis specialist, and patients with suspected retinal involvement underwent targeted ophthalmologic evaluation and treatment. Thirty-nine alloHSCT recipients (mean age 48.8 years; 51.3

PurposeTo evaluate serum adalimumab (ADA) levels in patients with non-infectious uveitis (NIU), identify factors associated with drug exposure—including anti-adalimumab antibodies (AAA)—and assess their relationship with control of intraocular inflammation.MethodsThis retrospective, observational, single-center study included patients with NIU treated with ADA who underwent at least one proactive assessment of serum ADA levels and AAA between October 2019 and January 2024 at Hospital Clínic de Barcelona (Spain).ResultsA total of 135 measurements were obtained from 65 patients. Mean serum ADA levels were higher in patients with complete response (8.28 µg/mL) compared with partial responders (5.57 µg/mL; p = 0.016) and non-responders (6.21 µg/mL; p = 0.012). AAA were detected in 18/135 measurements (13.3%). Patients with detectable AAA had markedly lower serum ADA levels (1.44 µg/mL; p < 0.0001). Lower ADA levels were also associated with male sex (p = 0.011), obesity (body mass index >30 kg/m²; p = 0.006), panuveitis (p < 0.0001), presence of vitritis (p = 0.0002), and longer disease duration (p < 0.0001). No significant differences were observed between ADA monotherapy and combination therapy with conventional immunomodulators (p = 0.91).ConclusionsIn NIU, patients achieving complete inflammatory control showed higher serum ADA levels than those with partial response or persistent disease activity, suggesting an association between drug exposure and inflammatory control. ADA exposure is influenced by patient- and disease-related factors, including body mass index, inflammatory burden, anatomical classification, immunogenicity, and dosing strategy. These findings support a potential role for proactive therapeutic drug monitoring to guide individualized treatment strategies.

PURPOSE:Ocular toxoplasmosis (OT) is the most common cause of posterior uveitis globally, with a significant risk of visual impairment. However, the lack of standardized data collection hinders meaningful comparisons across studies. This study aimed to develop a consensus-based set of Common Data Elements (CDEs) for observational studies in OT using a Delphi approach. DESIGN:A set of CDEs was developed through a combination of a comprehensive literature review, a hybrid workshop, and a Delphi consensus process. This effort was led by an international panel of experts in OT to define a standardized CDE set for research and clinical purposes. METHODS:A multidisciplinary steering committee identified an initial list of candidate CDEs through a targeted literature review. A panel of 30 international experts participated in a structured, one-round Delphi process to evaluate and refine these CDEs. Consensus was determined based on predefined thresholds for inclusion, exclusion, and modification. RESULTS:A total of 139 CDEs were categorized across nine domains: Demographic and Background Information, Medical and Ocular History, Clinical Presentation, Clinical Findings, Lesion Characteristics, Diagnostics, Imaging Findings, Treatment and Interventions, and Outcomes. All 139 CDEs met the inclusion criteria, with 79.8% rated as "very important". The consensus underscores the importance of a comprehensive, standardized dataset for OT research. CONCLUSIONS:This study establishes the first expert-derived standardized dataset requested for reporting OT outcomes, providing a framework to standardize data collection for future observational studies. Adopting these CDEs will enhance data comparability, improve meta-analyses, and strengthen the evidence base for clinical decision-making in OT. Future work will focus on real-world validation and refinement of this dataset.

OBJECTIVE:To describe the clinical features of a case series of patients with Vogt-Koyanagi-Harada (VKH)-like disease secondary to anticancer treatment. METHODS:Retrospective, non-interventional multicentre case-series study. Seventeen patients (34 eyes) with VKH-like disease secondary to anticancer treatment, seen between 2014 and 2023. Main outcome measures were patients' extraocular and ophthalmic clinical features, treatment, visual outcome, and complications. RESULTS:Fourteen out of 17 patients presented with skin melanoma. The main anticancer therapies were BRAF/MEK inhibitor (8/17 patients) and PD1 inhibitor (4/17 patients). Fifteen patients presented with ocular symptoms within 16 weeks after initiating anticancer therapy. Most of the eyes exhibited anterior chamber cells (n = 30), flare (n = 20), and vitritis (n = 11). All patients had subretinal fluid, and 24/34 eyes had foveal involvement. The mean subfoveal choroidal thickness measured by EDI-OCT was 483.42 ± 262.46 µm. In 12 cases, the oncology team decided to stop the anticancer therapy, and all but one patient was treated with high-dose oral corticosteroids for a median of 16 weeks. At the last follow-up visit, control of ocular inflammation had been achieved in 16 cases (median follow-up: 62 weeks, range 16-104 weeks). The most common complications were cataract and ocular hypertension (10 patients). CONCLUSIONS:VKH-like features in the context of emerging novel anticancer therapies represent a unique clinical phenotype in which the cornerstone of management should include high doses of systemic corticosteroids, using immunomodulatory therapy as a second-line treatment in patients with a refractory disorder. In addition, a comprehensive multidisciplinary approach, including an oncologist, should consider the safety of anticancer treatment cessation.

The CINCA syndrome is an inflammatory disease characterised by persistent rash and chronic aseptic meningitis, with extensive infiltration of polymorphonuclear and macrophage cells at the sites of inflammation. The CINCA syndrome belongs to the group of systemic autoinflammatory diseases characterised by episodic or fluctuating degrees of inflammation, without evidence of high-titre autoantibodies or antigen-specific T cells. The disease is caused by mutations in the CIAS1 gene that encodes a protein cryopyrin, NALP3 or PYPAF1. Mutations in cryopyrin have a profound pro-inflammatory effect. Cryopyrin is a caspase 1 activator, which in turn causes the activation of interleukin (IL)1ß. The activating mutations of cryopyrin induce an excessive activation of IL1ß, which causes an influx of macrophages and polymorphonuclear cells to the site of inflammation, in our patient, in his eye.

BackgroundHydroxychloroquine is recommended for all patients with systemic lupus erythematosus (SLE) because of its efficacy and safety. Previous studies of antimalarial toxicity under non-experimental conditions have often grouped hydroxychloroquine and chloroquine. This study focuses on the long-term toxicity of antimalarial drugs in SLE patients at a single reference centre. The research seeks to identify trends in antimalarial toxicity and determine risk factors contributing to long-term adverse effects.Materials and MethodsRetrospective data were collected from electronic medical records of consecutively diagnosed SLE patients, followed for at least 5 years, from 1998 to 2017. The outcome variable "antimalarial long-term adverse effect" was considered if the adverse effect occurred after at least 5 years of continuous antimalarial treatment. Hazard regression analysis was used to identify independent factors associated with long-term antimalarial adverse effects.ResultsThree hundred 22 patients followed for a median of 15 years were analysed. The mean age at SLE diagnosis was 33.4 years, and 91.3% were women. Antimalarial drugs were started in 314 (97.5%) patients. Adverse effects were observed in 55 (17.5%) patients, mainly macular toxicity (11.5%). The incidence of all types of toxicity was higher in the long-term users than in the short-term users (12.1% vs 5.4%; p < .001). Previous use of chloroquine (HR 3; 95%CI 1-9), anti-ß2-glycoprotein antibody positivity (HR 2; 95%CI 1-4) and hydroxychloroquine doses higher than 5 mg/kg/day (HR 2.6; 95%CI 1-7) were identified as independent factors associated with long-term antimalarial toxicity.ConclusionsIn our experience over the past 20 years, almost all SLE patients were treated with antimalarials. Macular toxicity was the most common long-term adverse effect. Patients with previous use of chloroquine, higher than recommended doses of hydroxychloroquine, and positive anti-ß2-glycoprotein antibodies were more likely to develop long-term antimalarial toxicity.

Choroidal neovascularization (CNV) and inflammation play an important role in retinal disease development and the acute phase reactant C-reactive protein (CRP) has been shown to contribute to Age-related macular degeneration (AMD) in vitro. Our aim was to evaluate whether monomeric and pentameric CRP (pCRP, mCRP) isoforms contribute to CNV in vivo and to characterize the mechanism of CRP dissociation in-vivo and in vitro. Both CRP isoforms were intravitreally (IVT) or intravenously (IV) injected in mice, CNV was laser-induced, retinography and fluorescein angiography were performed to evaluate edema. Lectin, mCRP, F4/80 and C5b9 localization were assessed by immunofluorescence and visualized under a confocal microscope. CNV, intensity of fluorescence of mCRP (IF mCRP) was also quantified. To confirm pCRP dissociation in RPE cells and mice, pCRP was coupled to a fluorochrome and IVT injected. A statistical increase in CNV areas was observed in pCRP IVT injected males (p < 0.05) while a statistical decrease was shown in females (p < 0.05). After IV injection, pCRP males showed an increase in CNV areas only vs. mCRP injected mice (p < 0.05) and in females the injection of pCRP injected mice showed higher CNV areas vs. vehicle (p < 0.05) and vs. mCRP injected mice (p < 0.05). Retinal edema after IVT CRP injection was observed mainly in mCRP injected mice. In females there was an IF mCRP statistical decrease in pCRP IVT injected mice vs. vehicle and a statistical increase in pCRP IV injected mice vs. vehicle (p < 0.05). Mice injected with IVT isoforms showed F4/80 positive cells and C5b-9 deposition around the CNV areas. mCRP labeling was observed in the intercellular space of the endothelial cells in the angiogenic area and detected in pCRP IVT injected animals, demonstrating the dissociation of pCRP into mCRP both in vitro and in vivo in proinflammatory microenvironments. In conclusion, CRP administration increased the area of CNV and the edema observed in the subretinal space, suggesting that CRP is activated in the CNV inflammatory environment. In addition, we demonstrated that pCRP dissociates in vivo into mCRP in damaged areas close to CNV, hypothesizing that the CNV process is exacerbated by mCRP.

Introduction:C-reactive protein (CRP) plays a critical role in the innate immune system and serves as a biomarker for various inflammatory conditions. CRP is a dynamic protein undergoing conformational changes between pentameric (pCRP) and monomeric (mCRP) conformations. pCRP is the well-established systemic marker of inflammation, while mCRP is associated with localized tissue inflammation. Methods:This study aimed to evaluate systemic levels of pCRP, mCRP, interleukin-6 (IL-6), and interleukin-1β (IL-1β) in patients with a variety of intraocular inflammatory conditions, including diabetic macular edema (DME) and non-infectious uveitis such as Behçet's disease (BD), Birdshot retinochoroidopathy (BSRC), HLA-B27-associated uveitis, and undifferentiated uveitis (UU). Results:A total of 77 subjects were included. mCRP levels were significantly elevated in BD, DME, and UU compared to controls (p = 0.014, p = 0.036, and p = 0.031, respectively). The mCRP/pCRP ratio was also significantly higher in DME and UU (p = 0.035 and p = 0.011, respectively). In addition, a strong positive correlation was observed between IL-6 and IL-1β (ρ = 0.638, p <0.0001). No significant differences in serum levels of pCRP, IL-6, or IL-1β were observed among the groups. Conclusions:These findings suggest that mCRP, rather than pCRP, may be a more specific systemic biomarker for certain intraocular inflammatory conditions. The involvement of the CRP axis and the strong correlation between IL-6 and IL-1β underscore the interaction of these key inflammatory mediators, providing further insight into the targeting of CRP axis for therapeutic purposes.

Objective To compare multimodal structural and functional diagnostic methods in patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine, to identify the best complementary approach for detecting subclinical retinal toxicity.Methods A cross-sectional, unicentric study was conducted on patients with SLE treated with hydroxychloroquine. Each patient underwent a comprehensive ophthalmic evaluation, comprising structural tests (spectral-domain optical coherence tomography (SD-OCT), en face OCT, en face OCT angiography (OCTA), fundus autofluorescence (FAF)) and functional tests (automated perimetry for visual field (VF) testing, multifocal electroretinography (mfERG)). A diagnosis of macular toxicity required the presence of abnormalities in at least one structural and functional test. The Kappa Concordance Index was used to assess the concordance among the different tests in detecting potential macular toxicity-associated alterations.Results Sixty-six patients with SLE (132 eyes) were consecutively enrolled. Four (6.1%) patients developed subclinical hydroxychloroquine-induced retinal toxicity without visual acuity impairment. The proportion of abnormal results was 24% for both en face OCT and en face OCTA. Regarding functional analysis, VF was less specific than mfERG in detecting subclinical retinal toxicity (VF specificity 47.5%). En face OCT and en face OCTA structural findings showed better concordance, with a kappa index >0.8, and both identified the same cases of toxicity as FAF.Conclusion Although structural OCT and VF are frequently used to screen for hydroxychloroquine-induced retinal toxicity, our findings suggest that a combination of mfERG, en face OCT and en face OCTA could improve the diagnostic accuracy for subclinical retinal damage. This study emphasises the importance of a multimodal imaging strategy to promptly detect signs of hydroxychloroquine-induced retinal toxicity.

Objective: This study aimed to examine microvascular changes and identify predictors of short-term quiescence in active birdshot chorioretinitis (BSCR). Methods: An observational, prospective, 12-month follow-up cohort study was conducted. BSCR eyes were clinically assessed at baseline, categorized as active or inactive, and reevaluated at 12 months. Based on their clinical activity at both timepoints, eyes were divided into three subgroups: active-to-inactive (A-I), consistently active (A-A), and consistently inactive (I-I). Structural OCT, OCT-angiography (OCT-A), and ultra-widefield imaging were utilized. Exam data from fundus and nasal subfields were analyzed for microvascular changes and quiescence predictors. Results: Sixty eyes from 30 BSCR patients (47% women, 53% men, mean age 59.7 ± 12.3 years) were included. In the A-I group (16 eyes), vascular density and perfusion indices increased in all subfields post-quiescence, contrasting with the other groups. Perifoveal looping in the superficial capillary plexus predicted quiescence at 12 months compared with the A-A group. Conclusions: Vascular density rises after complete inflammation control in BSCR, and perifoveal capillary loops serve as potential predictors of short-term quiescence in active BSCR.

Purpose To evaluate and compare intraocular lens (IOL) tilt between uneventful phacoemulsification with in-the-bag IOL implantation and sutured scleral fixation (SSF) of the lens bag with a capsular tension segment (type 6 D / Morcher) using a Sheimpflug camera. Setting Clinical Practice, Hospital. Barcelona and A Coruña, Spain. Design Retrospective, comparative multicenter study. Methods IOL tilt was compared between patients who underwent sutured scleral fixation with a capsular tension segment in a single eye (SSF group, n = 15) with patients who underwent uneventful IOL implantation (control group, n = 12) that were matched by biometric measurements. Post-operative refractive accuracy of biometric formulas by means of mean absolute error (MAE) was also reported. All patients underwent a general ophthalmic evaluation, anterior segment photography, and postoperative optical biometry (Zeiss IOLMaster® 500). In addition, IOL tilt was measured with a Scheimpflug camera (Pentacam R, Oculus Optikgerate Gmbh). Results Mean vertical tilt was similar in both groups (2.20+/-2.47° SSF vs 1.97 +/- 1.79° control; p = 0.836) but mean horizontal tilt tended to higher values in the SSF series (2.09 +/- 2.74° vs 0.94 +/- 1.17°; p = 0.139). Considering post-operative refractive error in diopters by MAE calculations, there was an underestimation of IOL power in the SSF group which was only statistically significant for Barrett Universal II (1.07 vs 0.32; p = 0.028) and Hill-RBF (0.95 vs 0.26; p = 0.024) formulas, but not for SRK/T (0.99 vs 0.42; p = 0.285) and Kane (0.96 vs 0.33; p = 0.083). Conclusion Sutured scleral fixation of capsular tension segments in the presence of zonular instability does not seem to induce clinically significant IOL tilt compared to uneventful cataract extraction cases.

Aims/Purpose: Increased systemic levels of the acute phase reactant C‐reactive protein (CRP) have been linked to increased risk of age‐related macular degeneration (AMD). CRP undergoes conformational changes upon activation in inflammatory microenvironments between pentameric (pCRP) and monomeric forms (mCRP). CRP conformations present different phenotypes, as mCRP has more proinflammatory properties and has been shown to induce blood retinal barrier disruption in vitro. Thus, we aimed to evaluate the impact of CRP forms on choroidal neovascularization (CNV) in vivo. Methods: pCRP and mCRP forms were intravenously (iv) or intravitreally (ivt) injected in C57BL6/J mice ( n = 12) previously subjected to CNV induction by laser and compared to controls. CNV lesions were monitored by fluorescein angiography and mice were euthanized 11 days after lesion induction. CNV areas were measured in lectin stained choroidal flatmounts. To evaluate the CRP dissociation, pCRP was coupled to a fluorescent molecule before injection. After tissue extraction mCRP was detected by immunofluorescence in posterior pole flatmounts. Results: Both pCRP and mCRP injected significantly increased CNV areas compared to control mice. Retinal severe edema was also observed close to the lesion in retinographies, and was more severe in intravitreally injected groups. Finally, pCRP was observed to dissociate into mCRP in intravitreally injected animals with pCRP. Conclusions: We confirmed that CRP increases CNV areas and severe edema in the retina, suggesting that CRP is activated in the CNV inflammatory environment. Additionally, the pCRP form dissociates in vivo into mCRP close to CNV damaged tissue, hypothesizing that mCRP is the CRP conformation that contributes to the exacerbation of the CNV process. Further studies are needed to investigate anti‐mCRP molecules as candidates for mono‐ or anti‐VEGF combined therapy for AMD treatments.

PurposeTo determine and compare the serum levels of complement Factor H (FH), monomeric C-Reactive Protein (mCRP) and pentameric C-Reactive protein (pCRP) in patients with age-related macular degeneration (AMD) and to correlate them with clinical, structural and functional parameters.MethodsCross-sectional observational study. One hundred thirty-nine individuals (88 patients and 51 healthy controls) from two referral centers were included and classified into three groups: early or intermediate AMD (n=33), advanced AMD (n=55), and age and sex matched healthy controls (n=51). Serum levels of FH, mCRP, and pCRP were determined and correlated with clinical and imaging parameters.ResultsPatients with intermediate AMD presented FH levels significantly lower than controls [186.5 (72.1-931.8) µg/mL vs 415.2 (106.1-1962.2) µg/mL; p=0.039] and FH levels <200 µg/mL were associated with the presence of drusen and pigmentary changes in the fundoscopy (p=0.002). While no differences were observed in pCRP and mCRP levels, and mCRP was only detected in less than 15% of the included participants, women had a significantly higher detection rate of mCRP than men (21.0% vs. 3.8%, p=0.045). In addition, the ratio mCRP/FH (log) was significantly lower in the control group compared to intermediate AMD (p=0.031). Visual acuity (p<0.001), macular volume (p<0.001), and foveal thickness (p=0.034) were significantly lower in the advanced AMD group, and choroidal thickness was significantly lower in advanced AMD compared to early/intermediate AMD (p=0.023).ConclusionIntermediate AMD was associated in our cohort with decreased serum FH levels together with increased serum mCRP/FH ratio. All these objective serum biomarkers may suggest an underlying systemic inflammatory process in early/intermediate AMD patients.

Background: The leading cause of blindness due to non-infectious uveitis is cystoid macular edema (CME). Behçet’s disease (BD) is one of the most commonly conditions related to CME. Objectives: To compare the effectiveness and safety of adalimumab (ADA), infliximab (IFX) and certolizumab (CZP) in refractory CME due to BD. Methods: Multicenter study of BD-CME patients with no response to glucocorticoids (GCs) and at least one conventional immunosuppressive drug. At baseline, all patients presented CME, defined by OCT > 300 µ. The effectiveness of ADA, IFX and CZP was assessed over a 2-year period from baseline using the following ocular parameters: macular thickness (µm), visual acuity (BCVA), anterior chamber (AC) cells and vitritis. Mixed-effects regression models were applied. Results: a total of 50 patients (75 eyes) were studied (ADA = 25; IFX = 15 and CZP = 10). No significant differences in demographic parameters were found among the three groups. However, individuals in the CZP group had a significantly extended time from diagnosis to treatment onset (72 (36–120) months, p = 0.03) and had received a higher number of biological therapies (1.7 ± 1.1) compared to the ADA and IFX groups. Within the CZP group, ADA and IFX were previously administrated in seven patients. After 2 years of follow-up, a rapid and sustained reduction in macular thickness was noted in all three groups with no significant differences between them. Additionally, enhancements in BCVA, AC cells and vitritis were also observed. No serious adverse events were reported in the CZP group, although one isolated case of bacteremia was documented in the ADA group. ADA, IFX and CZP appear to be effective and safe treatments for refractory CME in BD. CZP seems to remain effective even in patients with an insufficient response to ADA and/or IFX. Conclusions: ADA, IFX and CZP appear to be effective and safe treatments for refractory CME in BD. CZP seems to remain effective even in patients with an insufficient response to ADA and/or IFX.