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Manon E. Owen, George Morphis, Nicholas A. Beare, Ian A. Pearce; Preliminary Results Of Treatment With Intravitreal Methotrexate In Patients With Macula Oedema Secondary To Uveitis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1179.
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To evaluate the outcomes and safety profile of intravitreal Methotrexate in patients with cystoid macula oedema secondary to non-infectious uveitis.
Intravitreal Methotrexate (400mcg/0.1ml) was used in selected patients with cystoid macula oedema secondary to uveitis as an alternative to intraocular steroid to avoid the risks of raised intraocular pressure or cataract development. Best corrected visual acuity, Spectralis OCT and full dilated ocular examination was recorded at baseline and at each follow up appointment thereafter.
Six patients were included, four females and two males. The mean age of the patients was 49.5 years (range 28-75). All patients had cystoid macula oedema secondary to non-infectious uveitis. Three patients had idiopathic intermediate uveitis. The others had chronic anterior uveitis, autoimmune associated retinopathy and Birdshot chorioretinopathy. All patients were on oral immunosuppressive drugs. Three were known to be steroid responders. The range of visual acuity before the intravitreal Methotrexate was 20/40 to 20/200. The mean central foveal thickness was 455µm (311-728µm). Five patients had one 400mcg/0.1ml of intravitreal Methotrexate. One patient had two intravitreal injections of Methotrexate, 10 weeks apart. Visual acuity at one month follow up ranged from 20/60 to perception of light. The visual acuity improved in one patient, was stable in 2 and worsened in three patient. The mean central foveal thickness was 484µm (394-807µm) one month after the intravitreal injection. One patient developed cataract. The vision improved from perception of light to 20/80 following cataract surgery. There were no other ocular side effects.
Intravitreal Methotrexate is safe to use in patients with macula oedema secondary to non-infectious uveitis. Some of our patients responded positively to the intravitreal methotrexate, with one patient having no macula oedema 3 months after the injection. Intravitreal Methotrexate should be considered as a treatment option in patients known to be steroid responders.
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