Use of methotrexate in sarcoid-associated optic neuropathy.
OBJECTIVE
To demonstrate the possible beneficial effects of methotrexate (MTX) therapy for patients with sarcoid-associated optic neuropathy (SAON).


METHODS
Retrospective, noncomparative, interventional case series.


METHODS
Three patients diagnosed with SAON who received MTX. Two patients had tissue biopsies consistent with sarcoidosis, and 1 patient had clinically diagnosed sarcoidosis based on laboratory and radiographic studies. All 3 patients developed side effects with corticosteroid treatment of their optic neuropathy.


METHODS
Patients were treated with weekly doses of oral MTX and monitored with neuro-ophthalmic, medical, and laboratory examinations.


METHODS
Visual acuity, automated perimetry, and reduction of oral prednisone therapy.


RESULTS
After initiation of MTX, all 3 patients showed an improvement or stabilization of visual acuity. All patients had a decrease in their corticosteroid requirements, and all had improved or stabilized visual field deficits. One of the 3 patients developed leukopenia that necessitated a reduction of the methotrexate dose.


CONCLUSIONS
Methotrexate may be effective for SAON as an adjunct to corticosteroid therapy or as an alternative for corticosteroid-intolerant patients. Oral MTX reduced the corticosteroid requirements of 3 patients with SAON, and all 3 demonstrated stable or improved visual function.
Maust
Heather A
HA
Neuro-Ophthalmology Service, Jefferson Medical College, Thomas Jefferson University, Wills Eye Hospital, 900 Walnut Street, Philadelphia, PA 19107, USA.
Foroozan
Rod
R
Sergott
Robert C
RC
Niazi
Sultan
S
Weibel
Sandra
S
Savino
Peter J
PJ
D000328:Adult; D005260:Female; D005493:Folic Acid Antagonists / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D011241:Prednisone / Q000627:therapeutic use; D012507:Sarcoidosis / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D014792:Visual Acuity; D014794:Visual Fields
D005493:Folic Acid Antagonists; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011241:Prednisone; D008727:Methotrexate