Corneal Adverse Events Temporally Associated with Anti-TNF-α Therapy: Severe Fibrovascular Pannus and a Non-Pannus Epitheliopathy in Two Cases.

Purpose: To describe two corneal adverse events temporally associated with anti-tumor necrosis factor-α (TNF-α) therapy-one with severe fibrovascular pannus and another with epithelial keratopathy without pannus. Methods: Two patients on anti-TNF-α agents underwent comprehensive ocular examinations. Management included modification or discontinuation of biologics as clinically indicated and intensified topical therapy. Results: Case 1 (pustular psoriasis on adalimumab) developed bilateral fibrovascular pannus with stromal changes. Ocular findings did not improve immediately after adalimumab discontinuation but gradually improved following macrolide, topical corticosteroid, and immunomodulatory therapy. Case 2 (Crohn's disease on adalimumab then golimumab) presented with superior corneal haze and diffuse superficial punctate keratopathy without pannus and resolved with topical therapy alone. Conclusion: These cases raise the possibility that corneal adverse events-including severe pannus-may occur during anti-TNF-α therapy. Given the heterogeneity and potential confounders, causality cannot be established. Ophthalmic vigilance and further studies are warranted.