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Egbert Matthe, Dirk Sandner, Lutz Pillunat; Intravitreal Methotrexate for different inflammatory retinal conditions. Invest. Ophthalmol. Vis. Sci. 2013;54(15):261.
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The antiproliferative potential of methotrexate has been in use for years to control inflammation systemically and intraocular lymphoma processes intravitreally. We examined it’s effectiveness for controlling inflammatory conditions by intravitreal injection, mainly for uveitic patients, when all other treatment options did not show any benefit.
Data and history of 9 patients who were given 400 µg of methotrexate intravitreally up to three times for different conditions (4 with therapy refractory uveitic macular edema and one each with atypical retinopathia centralis serosa [RCS], persistent subretinal fluid after scleral buckling, anti-VEGF-refractory AMD, postoperative cystoid edema after macular hole and multiple glaucoma surgery) were retrospectively evaluated. Visual acuity, amount of intra- and subretinal fluid on SD-OCT, unwanted adverse events and time to recurrence were documented and are presented.
One of the four uveitic patients responded with improvement of visual acuity and reduction in fluid, as did the patient with the atypical RCS. The effect was gone four to six weeks after injection. All other patients did not show constant benefit in respect to visual acuity or amount of fluid in OCT. Only one adverse event was seen (intraocular pressure elevation in the patient with the history of multiple glaucoma surgery).
Treatment of patients with intravitreal methotrexate might be effective in terms of reducing intraretinal or subretinal fluid and improving visual acuity, but the rate of response is poor. Our data suggest to use intravitreal methotrexate only when all other established therapies have proven futile and the condition in question is clearly inflammatory. Therefore patients need to be selected carefully for this treatment.
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