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Maria K Gemenetzi, Andreas Karydis, Emily Shao, Victor Menezo, Simon Richard Taylor; Intensive intravitreal treatment with methotrexate for refractory cystoid macular edema secondary to intraocular inflammation: a small case series. Invest. Ophthalmol. Vis. Sci. 2014;55(13):610.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the intensive use of intravitreal methotrexate (MTX) for the treatment of refractory uveitic cystoid macular edema (CME).
We used an intensive regime of intravitreal MTX injections to treat 3 eyes of 3 patients with non-infectious uveitis associated with refractory CME, who also had a history of increased intraocular pressure (IOP) in response to corticosteroid administration. Informed consent was obtained from patients prior to treatment. The regime comprised 3 intravitreal injections of 400µg in 0.1 ml MTX administered at 2 weekly rather than the usual 3-monthly intervals. The primary outcome measures were visual acuity (VA) and central retinal thickness (CRT) on Spectral Domain Optical Coherence Tomography (SD OCT).
There was a cumulative reduction of at least 60 microns in CRT on SD OCT over the course of three injections, which had not been seen with previous treatments. However, none of the patients achieved total resolution of CME with this regime and there was no improvement in visual acuity. There were no adverse events.
Intensive treatment with intravitreal MTX appears to offer a cumulative effect in patients with non-infectious uveitis and refractory CME, but no patient achieved total resolution of CME and there was no improvement in visual acuity when only three injections were given. In contrast to previous corticosteroid administration, there was no increase in IOP, and no other adverse events were recorded, suggesting that the period of intensive administration could be lengthened further to maximise any cumulative effect.
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