The Effectiveness of Intraocular Methotrexate in the Treatment of Posterior Uveitis in Behçet’s Disease Patients Compared to Retrobulbar Steroids Injection

Abstract

Aim of Work. To evaluate the efficacy of intravitreal methotrexate (MTX) compared to retrobulbar triamcinolone acetonide (TAA), in controlling posterior segment involvement and inducing remissions among Behçet's disease (BD) patients. Study Design. This is a cross-sectional nonrandomized comparative study. Patients and Methods. 31 adult BD male patients with a mean disease duration of 5.45 years who presented with bilateral posterior segment involvement were included. Each patient received intravitreal injection of 400 μg/0.1 mL (MTX) for the right eye (Group A) and 1 mL of retrobulbar 40 mg/mL TAA for the left eye (Group B). Results. 90% of eyes showed complete improvement of anterior chamber reaction, whereas an improvement in vitreous activity in 77% with no significant differences between both groups (p ≤ 0.1). BCVA improved in 77.4% eyes (Group A) compared to 87.1% (Group B) (p ≤ 0.4). Relapses were noted in 11 eyes (35.5%), in group A, with the mean duration of remission being 19.1 weeks ± 2.13 compared to 7.35 ± 2.8 in 20 eyes (64.5%) in group B (p ≤ 0.1). Conclusion. No statistical differences were found between both treatment modalities; however, based on clinical observations, intravitreal MTX may ensure better control of inflammatory reaction and may encourage longer remission as compared to retrobulbar TAA in BD patients.

Pharmacological clearance of misfolded rhodopsin for the treatment of RHO ‐associated retinitis pigmentosa

“…MTX is water-soluble and it has been intravitreally administered as an off-tag treatment for inflammatory ocular diseases such as retina uveitis. [64][65][66] Thus, the novel activity of MTX in the selective clearance of the P23H rhodopsin and its retinal protective effects in the Rho P23H/+ mice make this drug with a therapeutic potential to be repurposed for the treatment of RHO-associated adRP.…”

Intravitreal injections of bevacizumab plus methotrexate versus bevacizumab alone for the treatment of diabetic macular edema: A randomized, sham-controlled trial

“…Similar to the present study, Khalil et al found no significant changes in the mean IOP values with intravitreal MTX. 20 Some studies have recently demonstrated that using intravitreal anti-VEGF injection decreases NO and PGI2 production and induces vasoconstriction and a tendency for hypertension. Intravitreal anti-VEGF can also promote thrombosis formation and the tendency for cardiovascular and cerebral events.…”

Intravitreal Methotrexate

“…In some patients, it also reduced the need for systemic immunosuppressive drugs. In another study, Khalil and coworkers, [57] evaluated the efficacy of intravitreal MTX in controlling posterior segment involvement of Behcet's disease (BD) in comparison to retrobulbar triamcinolone acetonide (TA). They showed that improvement of anterior chamber reaction and vitreous inflammation was similar between the two groups; however, relapses were noted less in patients who received intravitreal injection of 400 µg MTX.…”