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Intraocular methotrexate can induce extended remission in some patients in noninfectious uveitis.

AbstractPURPOSE:
To assess the outcomes of the intravitreal administration of methotrexate in uveitis.
METHODS:
Multicenter, retrospective interventional case series of patients with noninfectious uveitis. Thirty-eight eyes of 30 patients were enrolled, including a total of 54 intravitreal injections of methotrexate at a dose of 400 µg in 0.1 mL. The primary outcome measure was visual acuity. Secondary outcome measures included control of intraocular inflammation and cystoid macular edema, time to relapse, development of adverse events, and levels of systemic corticosteroid and immunosuppressive therapy.
RESULTS:
Methotrexate proved effective in controlling intraocular inflammation and improving vision in 30 of 38 eyes (79%). The side effect profile was good, with no reported serious ocular adverse events and only one patient having an intraocular pressure of >21 mmHg. Of the 30 eyes that responded to treatment, 8 relapsed, but 22 (73%) entered an extended period of remission, with the Kaplan-Meier estimate of median time to relapse for the whole group being 17 months. The eight eyes that relapsed were reinjected and all responded to treatment. One eye relapsed at 3 months, but 7 eyes again entered extended remission. Of the 14 patients on systemic therapy at the start of the study, 8 (57%) were able to significantly reduce this following intravitreal methotrexate injection.
CONCLUSION:
In patients with uveitis and uveitic cystoid macular edema, intravitreal MTX can effectively improve visual acuity and reduce cystoid macular edema and, in some patients, allows the reduction of immunosuppressive therapy. Some patients relapse at 3 to 4 months, but a large proportion (73%) enter an extended period of remission of up to 18 months. This larger study extends the results obtained from previous smaller studies suggesting the viability of intravitreal methotrexate as a treatment option in uveitis.
AuthorsSimon R J Taylor, Alay Banker, Ariel Schlaen, Cristobal Couto, Egbert Matthe, Lavnish Joshi, Victor Menezo, Ethan Nguyen, Oren Tomkins-Netzer, Asaf Bar, Jiten Morarji, Peter McCluskey, Sue Lightman
JournalRetina (Philadelphia, Pa.) (Retina) 2013 Nov-Dec Vol. 33 Issue 10 Pg. 2149-54 ISSN: 1539-2864 [Electronic] United States
PMID23615343 (Publication Type: Journal Article, Multicenter Study)
Chemical References
  • Immunosuppressive Agents
  • Methotrexate
Topics
  • Adult
  • Aged
  • Female
  • Follow-Up Studies
  • Humans
  • Immunosuppressive Agents (therapeutic use)
  • Intravitreal Injections
  • Macular Edema (drug therapy, physiopathology)
  • Male
  • Methotrexate (therapeutic use)
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome
  • Uveitis (drug therapy, physiopathology)
  • Visual Acuity (drug effects)
  • Young Adult

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