The primary aim of the study was to evaluate the efficacy of tumor necrosis factor (TNF)-α blockers adalimumab (ADA) and infliximab (IFX) in refractory sight-threatening retinal vasculitis (RV) during a 12-month follow-up period. Secondary aims were to evaluate (i) any impact of concomitant conventional disease-modifying anti-rheumatic drugs (cDMARDs) and different lines of biologic therapy; (ii) any difference in terms of efficacy between ADA and IFX; (iii) consequences of biotherapies on the best-corrected visual acuity (BCVA); (iv) corticosteroid-sparing effect; and (vi) ocular complications during anti-TNF-α treatment. Demographic, clinical, and therapeutic data were retrospectively collected from the medical records and statistically analyzed. Forty-eight patients (82 eyes) were recruited, 22 (45.8%) of which received IFX and 26 (54.2%) ADA. The percentages of patients achieving RV remission within 3 and 12 months were 54 and 86%, respectively. A significant decrease in RV detection was identified from baseline to 3-month ( p  < 0.0001) and 12-month ( p  < 0.0001) assessments and between 3-month and 12-month visits ( p  = 0.004). No differences were identified in terms of RV resolution between (i) patients undergoing monotherapy and those co-administered with cDMARDs at 3-month ( p  = 0.560) and 12-month ( p  = 0.611) follow-up; (ii) biologic-naïve patients and those already exposed to other biologics at 3-month ( p  = 0.497) and 12-month ( p  > 0.99) visits; and (iii) patients treated with ADA and those treated with IFX ( p  = 0.357). During the study period, a statistically significant corticosteroid-sparing effect was observed ( p  = 0.0002), while BCVA values did not significantly change ( p  = 0.950). Anti-TNF-α monoclonal antibodies have proved excellent results in patients with recalcitrant sight-threatening RV.