title: Intraocular methotrexate can induce extended remission in some patients in noninfectious uveitis.
abstract: OBJECTIVE
  To assess the outcomes of the intravitreal administration of methotrexate in uveitis.
  
  
  METHODS
  Multicenter, retrospective interventional case series of patients with noninfectious uveitis. Thirty-eight eyes of 30 patients were enrolled, including a total of 54 intravitreal injections of methotrexate at a dose of 400 µg in 0.1 mL. The primary outcome measure was visual acuity. Secondary outcome measures included control of intraocular inflammation and cystoid macular edema, time to relapse, development of adverse events, and levels of systemic corticosteroid and immunosuppressive therapy.
  
  
  RESULTS
  Methotrexate proved effective in controlling intraocular inflammation and improving vision in 30 of 38 eyes (79%). The side effect profile was good, with no reported serious ocular adverse events and only one patient having an intraocular pressure of >21 mmHg. Of the 30 eyes that responded to treatment, 8 relapsed, but 22 (73%) entered an extended period of remission, with the Kaplan-Meier estimate of median time to relapse for the whole group being 17 months. The eight eyes that relapsed were reinjected and all responded to treatment. One eye relapsed at 3 months, but 7 eyes again entered extended remission. Of the 14 patients on systemic therapy at the start of the study, 8 (57%) were able to significantly reduce this following intravitreal methotrexate injection.
  
  
  CONCLUSIONS
  In patients with uveitis and uveitic cystoid macular edema, intravitreal MTX can effectively improve visual acuity and reduce cystoid macular edema and, in some patients, allows the reduction of immunosuppressive therapy. Some patients relapse at 3 to 4 months, but a large proportion (73%) enter an extended period of remission of up to 18 months. This larger study extends the results obtained from previous smaller studies suggesting the viability of intravitreal methotrexate as a treatment option in uveitis.
authors.affiliation: *Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK; †Division of Immunology & Inflammation, Faculty of Medicine, Imperial College London, London, UK; ‡Banker's Retina Clinic and Laser Centre, Ahmedabad, Gujarat, India; §Department of Uveitis, University of Buenos Aires, Buenos Aires, Argentina; ¶Department of Ophthalmology, Hospital Universitario Austral, Buenos Aires, Argentina; **Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Carl Gustav Carus, an der Technischen Universität Dresden, Dresden, Germany; ††Department of Ocular Biology & Therapeutics, UCL Institute of Ophthalmology, London, UK; ‡‡Save Sight Institute, Sydney Eye Hospital, Sydney, Australia; §§Department of Clinical Ophthalmology and Eye Health, Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Simon R J
authors.initials: SR
authors.lastname: Taylor
authors.forename: Alay
authors.initials: A
authors.lastname: Banker
authors.forename: Ariel
authors.initials: A
authors.lastname: Schlaen
authors.forename: Cristobal
authors.initials: C
authors.lastname: Couto
authors.forename: Egbert
authors.initials: E
authors.lastname: Matthe
authors.forename: Lavnish
authors.initials: L
authors.lastname: Joshi
authors.forename: Victor
authors.initials: V
authors.lastname: Menezo
authors.forename: Ethan
authors.initials: E
authors.lastname: Nguyen
authors.forename: Oren
authors.initials: O
authors.lastname: Tomkins-Netzer
authors.forename: Asaf
authors.initials: A
authors.lastname: Bar
authors.forename: Jiten
authors.initials: J
authors.lastname: Morarji
authors.forename: Peter
authors.initials: P
authors.lastname: McCluskey
authors.forename: Sue
authors.initials: S
authors.lastname: Lightman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D058449:Intravitreal Injections; D008269:Macular Edema / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014605:Uveitis / Q000188:drug therapy* / Q000503:physiopathology; D014792:Visual Acuity / Q000187:drug effects; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D008727:Methotrexate