June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Serial treatment of uveitis with intravitreal injections of Methotrexate during the COVID-19 pandemic
Author Affiliations & Notes
  • Oleksandra Kovalova
    Wagner and Kapoor Research Institute, Virginia, United States
  • Kapil Kapoor
    Wagner and Kapoor Research Institute, Virginia, United States
  • Footnotes
    Commercial Relationships   Oleksandra Kovalova, None; Kapil Kapoor, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1401. doi:
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      Oleksandra Kovalova, Kapil Kapoor; Serial treatment of uveitis with intravitreal injections of Methotrexate during the COVID-19 pandemic. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1401.

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Abstract

Purpose : Uveitis is potentially sight-threatening and typically managed with steroids. However, chronic steroid therapy has known systemic and ocular adverse effects. Intravitreal methotrexate (MTX) is a unique option for local treatment that is steroid-sparing, but also immunosuppressive and anti-inflammatory. The purpose of our research is to assess the efficacy of serial intravitreal injections of MTX for uveitis.

Methods : This was a retrospective case series, reviewing three patients with non-infectious uveitis who received a series of intravitreal MTX from February to November 2020. Complete eye exams were performed at baseline and during each follow-up after the initial treatment, with recordings of key outcome measures including cystoid macular edema as measured by foveal thickness, intraocular pressure (IOP), visual acuity (VA), and anterior chamber activity.

Results : Three patients (2 female and 1 male) were diagnosed with panuveitis (33.3%) and posterior uveitis (66.7%) with mean age of 62.3 (59-68). Two patients received a series of three MTX injections (0.04ml of 25mg/ml) at one month intervals followed by one injection every three months thereafter; another patient received intravitreal MTX monthly without interval extension. Patient A formerly took 60 mg oral Prednisone daily, and reduced to 30 mg daily after bridging to local MTX without relapse; patient B received Ozurdex treatment that did not have interval extension but did have reduction in CME. Patient C had reduction in topical steroid therapy. The mean foveal thickness at baseline was 345 (range 248-469) and improved to 316 (range 361-397). Anterior chamber activity improved on average from a baseline of 1+ Cell/Flare to Trace Cell/Flare. The average IOP was in target range between 8-16 mmHg throughout treatment. The average VA improved by one line in the affected eye by the end of the studied treatment courses.

Conclusions : After initiation of intravitreal MTX treatments, all patients achieved measurably decreased clinical signs of inflammation and/or achieved significant reduction in steroid treatment. More research with randomized trials is needed to further elucidate the role of intravitreal MTX as a local steroid-sparing agent for uveitis. It may play an expanded role during the pandemic when systemic immunosuppression is relatively contraindicated and rheumatology support is less achievable.

This is a 2021 ARVO Annual Meeting abstract.

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