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R. N. Hamam, C. Foster; Intravitreal Methorexate for Acute Non Infectious Uveitis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2865.
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Methotrexate is an important agent in the armamentarium of immunomodulatory therapy for non infectious ocular inflammation. It can be administered via the oral, intravenous or intraocular route. Systemic administration is reportedly associated with potentially serious side effects in 8% of the cases. Intraocular Methotrexate has been reported to be safe in studies of management of primary intraocular lymphoma. We examined the efficacy of intraocular Methotrexate injection in controlling acute ocular non infectious inflammation.
Retrospective chart review of 9 patients receiving intraocular Methotrexate injection for uncontrolled active ocular inflammation. Best corrected visual acuity & grade of anterior and posterior segment ocular inflammation were recorded pre-injection and 1 day, 1 week, 6 weeks & 12 weeks after the procedure. Complications were recorded.
Ten eyes of 9 patients were evaluated. 3 patients were diagnosed with sarcoid associated uveitis, 2 patients with HLA B27 associated uveitis, 2 patients with intermediate uveitis and 2 patients with idiopathic panuveitis. Mean age was 46 years (range 7-62), 56% males, 60% OS. Eight eyes (80%) had active anterior & posterior inflammation prior to the injection, 1 eye (10%) had active anterior inflammation only & 1 eye (10%) had active posterior inflammation only. Four eyes (40%) had cystoid macular edema. Initial mean BCVA was 20/70 (range 20/20- 20/125). 8 (89%) patients were on IMT at the time of the injection. 400 mcg of Methotrexate was injected intravitreally in 9 eyes and intracamerally in 1 eye. One eye received 2 intravitreal injections of 400 mcg 6 weeks apart. Concomitant treatment included injection of 4 mg of Kenalog in the vitreous of 5 eyes, PPV in 1 eye, & initiation of oral MTX in 1 patient. Change in treatment after the injection included intravitreal 4 mg Kenalog injection in 2 eyes within 2 weeks, intracameral injection of 4 mg Kenalog in 1 eye and intravitreal injection of Avastin in 1 eye. IMT was increased in 2 patients. Three eyes (30%) gained 2 or more snellen lines 1 week after the injection. Five eyes (50%) gained 2 or more lines at 6 weeks and at 12 weeks. Vision decreased in 2 eyes at 1 week and in 1 eye at 6 and 12 weeks. Inflammation resolved in 4 eyes at 1 week, 5 eyes at 6 weeks and 7 eyes at 12 weeks. Inflammation increased in 4 eyes at one week, in 2 eyes at 6 weeks and in 1 eye at 12 weeks. No complications were reported.
80% of the studied eyes had concomitant and/or subsequent treatments that favorably influenced the outcome. However, intravitreal Methotrexate injection might be considered in eyes with active inflammation in which steroids are contraindicated.
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