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Karina Julian, Beate J. Langner-Wegscheider, Anton Haas, Marc D. De Smet; Intravitreal Methotrexate in the Management of Presumed Tuberculous Serpiginous-like Choroiditis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1181.
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To report on the use of intravitreal Methotrexate (IVT MTX) as part of treatment of presumed tuberculous Serpiginous-like Choroiditis (tb-SLC).
Case series of two patients suffering from Serpiginous-like Choroiditis with positive tuberculin skin test who received IVT injections of MTX as part of their treatment. In both cases, ocular involvement was bilateral and mild vitreitis was present. Ocular disease was active despite of the use of systemic tuberculostatic drugs (isoniazide, ryphampicine and pyridoxine). A single injection of IVT MTX (400µg/0.1ml) was administered in the more compromised eye of each patient (defined as the eye with the larger active lesion and/or less visual acuity). Patients were followed up for a mean of 13.5 months.
In both patients, visual acuity improved in the eye treated with IVT MTX within the first month after the injection and remained stable or further improved during the follow up. No adverse reaction was related to the injected drug or to the procedure.
The use of IVT MTX seems to be useful in the management of the inflammatory component of tb-SLC, while systemic tuberulostatics are aimed to control the infectious component of the disease. Whereas corticosteroids may worsen the evolution of tuberculous related choroiditis, MTX would be a useful agent in its management.
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