title: Toxic corneal epitheliopathy after intravitreal methotrexate and its treatment with oral folic acid.
abstract: OBJECTIVE
  To determine whether oral folic acid can ameliorate an iatrogenic, visually significant corneal epitheliopathy, which commonly occurs with intravitreal injections of methotrexate for the treatment of intraocular lymphoma.
  
  
  METHODS
  We report 2 cases of visually significant corneal epitheliopathy occurring after intravitreal injections of methotrexate for intraocular lymphoma. The first patient did not receive any treatment for the corneal disease, and the second patient with bilateral intraocular lymphoma received 1 mg of oral folic acid daily, a commonly used dosage for patients on systemic methotrexate.
  
  
  RESULTS
  In the first patient without treatment, there was a complete regression of the corneal epithelial disease only when the frequency of intravitreal methotrexate was reduced from weekly to monthly as per a commonly used dosage regimen for methotrexate. In the second patient, the corneal disease improved 80% within 1 week of initiating oral folic acid for her eye already experiencing severe epitheliopathy during her weekly dosing regimen of methotrexate and also had significantly decreased epithelial disease in her second eye that started weekly intravitreal methotrexate several weeks after beginning oral folic acid.
  
  
  CONCLUSIONS
  Currently, oral folic acid supplements are recommended for patients using systemic methotrexate to minimize drug toxicity. We suggest a similar use in patients undergoing intravitreal methotrexate injections to decrease toxic effects on the corneal epithelium.
authors.affiliation: Department of Ophthalmology, University of California, San Francisco, San Francisco, CA 94143-0730, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Gorovoy
authors.forename: Tidarat
authors.initials: T
authors.lastname: Prechanond
authors.forename: Maravillas
authors.initials: M
authors.lastname: Abia
authors.forename: Armin R
authors.initials: AR
authors.lastname: Afshar
authors.forename: Jay M
authors.initials: JM
authors.lastname: Stewart
mesh_terms: D000284:Administration, Oral; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D003316:Corneal Diseases / Q000139:chemically induced / Q000188:drug therapy*; D004791:Enzyme Inhibitors / Q000009:adverse effects*; D005134:Eye Neoplasms / Q000188:drug therapy; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D006801:Humans; D058449:Intravitreal Injections; D008223:Lymphoma / Q000188:drug therapy; D008727:Methotrexate / Q000009:adverse effects*; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D004791:Enzyme Inhibitors; D005492:Folic Acid; D008727:Methotrexate