Intravitreal Methotrexate Injections in the Treatment of Choroidal Neovascularization in Age–Related Macular Degeneration

Abstract

Abstract: : Purpose: To evaluate the outcome of repeated intravitreal injections of methotrexate (MTX) in the treatment of neovascular age–related macular degeneration. MTX possesses immunosuppressive, antiproliferative and antiangiogenetic properties. Recruitment of inflammatory cells and their expression of angiogenetic factors have been shown to contribute to the pathogenesis of choroidal neovascularizations. Experimentally, MTX is capable to inhibit ocular neovascularization. Intravitreal injections have previously been performed for intraocular lymphoma only, and without evidence for toxicity in the dosage applied herein. Methods: This prospective, nonrandomized clinical interventional study so far included 7 patients suffering from progressive exudative age–related macular degeneration with occult subfoveal choroidal neovascularization (CNV). Intravitreal injections of 400 µg MTX in 0.1 ml were performed once a week over a period of 6 weeks. Baseline and regular examinations during and after treatment include visual acuity (ETDRS), fluorescein angiography, optical coherence tomography (OCT3), microperimetry (MP1–Nidek), ERG, and complete blood count. Results: During a review period of 2 months, mean visual acuity has so far remained stable at 20/100, while mean foveal thickness on OCT showed a decrease from 282 µm to 223 µm. On fluorescein angiography a reduction in leakage was noted in 3 of 7 patients. There was no evidence of toxic side effects based on morphological and functional examinations including ERGs. Conclusions: These preliminary findings indicate that repeated intravitreal injections of MTX merit further study for the treatment of neovascular AMD. To increase injection intervals the development of a slow release form is underway.

Keywords: age-related macular degeneration • choroid: neovascularization • injection