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Sylvana Ventzke, Antonia Bottesi, Olga Furashova, Dirk Sandner, Lutz E Pillunat, Egbert Matthe; Systemic Methotrexate for treatment of chronic relapsing Central Serous Chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3721.
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Central serous chorioretinopathy (CSC) is a common disease characterized by exsudation from leaking choroidal vessels resulting in detachment of the retinal pigment epithelium or neurosensory retina leading to decreased visual acuity. Inflammation is a presumed contributing factor. We examined the effect of systemic Methotrexate (MTX), an antimetabolite and anti-inflammatory drug, for the treatment of chronic relapsing CSC (crCSC).
Retrospective evaluation of data and history of 7 patients (male) with crCSC who did not respond to (diuretics, aspirin, eplerenone, anti-VEGF intravitreally), could not receive (photocoagulation), or did not wish other treatment (photodynamic therapy, anti-VEGF intravitreally). Duration of CSC was at least 12 month with at least 1 recurrence. Each patient was treated with 7,5 mg weekly for at least 3 month. Visual acuity was obtained and central foveal thickness was measured with spectral domain OCT.
1 patient had complete reduction of subretinal fluid without need for any other treatment. Therapy is ongoing and he remained free of relapse for 12 month. In contrast, 6 patients had no reduction in the subretinal and sub-pigmentepithelial fluid during treatment with MTX; 3 of them showed even increase in the amount of fluid. Therapy had to be stopped because of side effects in 2 cases after 3 month and was abandoned in the four remaining patients after 4 month without effect.
The anti-inflammatory effect of systemic MTX is the rationale for use in crCSC. Therapy was generally well tolerated, with only mild side effects. The rate of response is comparatively low and MTX should only be considered in cases of mild chronic form, where long treatment duration is needed and seems to be unharmful, as the initiation phase of three month might otherwise result in photoreceptor damage and vision loss in non-responders.
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