Intravitreal Methotrexate in Uveitis

Intraocular Methotrexate Can Induce Extended Remission in Some Patients in Noninfectious Uveitis

“…25 Of the 30 patients in our study who responded to intravitreal MTX, 22 entered an extended period of remission (73%), with the Kaplan-Meier estimate of the time to relapse for the group as a whole being 17 months. This was an unexpected finding and extends the results of the previous studies by ourselves and others 7,9,11 -patients who relapse early do so at 3 to 4 months, but a significant cohort enter an extended period of remission. Whether it is the anti-inflammatory or cytotoxic effects of MTX that are responsible for long-term remission is unclear, but the same effects are not seen after systemic MTX administration, presumably because intravitreal levels only reach a tenth of blood levels after systemic dosing.…”

“…This study expands the results of previous smaller series 6,7,9,11 and also suggests that intravitreal MTX administration may lead to an extended duration of disease remission in some patients, 3,14 with the estimated median time to relapse in this study being 17 months. The results of our study need to be interpreted with caution, owing to the biases inherent in such retrospective data.…”

“…4,5,7,9 Rabbit electroretinogram studies have shown that this dose is nontoxic, 15 possibly because proliferating lymphoid cells are more sensitive to its effects than other tissues. 16 Importantly, MTX has not been reported to induce ocular hypertension, a complication of up to 40% of injections of intravitreal triamcinolone, 2 and only 1 of the 38 eyes in this study had a raised intraocular pressure after MTX administration.…”

“…We did not include any data from our previously reported prospective clinical trial in this study. 7,9 Patients with active posterior uveitis, intermediate uveitis, and panuveitis, or uveitic CME who underwent intravitreal MTX injections for the treatment of their condition were included and were recruited from clinics in Guildford, UK; Buenos Aires, Argentina; Dresden, Germany; Ahmedabad, India; and Sydney, Australia. Patients' data obtained from clinical records included age, gender, anatomic classification of the uveitis, 12 and time of follow-up.…”

“…9 This raised the intriguing prospect that intravitreal MTX may be able to induce more sustained disease remission in a significant subset of patients, in contrast to the effects observed with intravitreal corticosteroids. 1,10 Other groups have also now reported positive results from the use of intravitreal MTX in uveitis.…”