title: Intravitreal injection of methotrexate in persistent diabetic macular edema: a 6-month follow-up study.
abstract: OBJECTIVE
  To evaluate the efficacy of intravitreal injection of methotrexate (MTX) in patients with persistent diabetic macular edema (DME) nonresponsive to intravitreal bevacizumab.
  
  
  METHODS
  In this prospective, interventional study, intravitreal injection of 400 μg MTX was performed in eyes with persistent center-involving DME unresponsive to at least three consecutive bevacizumab injections or two consecutive bevacizumab injections plus macular photocoagulation. Best-corrected visual acuity (BCVA), central subfield thickness (CST), and maximum retinal thickness (MRT) were recorded before and 1, 3, and 6 months after injections.
  
  
  RESULTS
  Eighteen eyes of 16 patients with a mean age of 61.1 ± 6.7 years were included. Mean number of intravitreal bevacizumab injections was 3.9 ± 1.8 (range 2-8). The mean change in BCVA was -0.09 ± 0.19, -0.1 ± 0.19, and -0.1 ± 0.19 LogMAR at 1, 3, and 6 months after intravitreal MTX injections, respectively (all P = 0.04). Three eyes (16.6 %) had improvement of at least two lines of BCVA and no eye lost visual acuity. Mean change in CST was -23.7 ± 66.7, -28.7 ± 82.2 and 26.5 ± 83.4 μm at 1, 3, and 6 months after MTX injections, respectively (all P = 0.1). A decrease in CST was found in 13 eyes (72.2 %) at 1 and 3 months, and seven eyes (38.8 %) at 6 months of follow-up. Other eyes showed an increase in CST measurements. Mean change in MRT was -35.1 ± 76.4, -40.6 ± 86.3, and 29.8 ± 68.6 μm at 1, 3, and 6 months after MTX injections, respectively (P = 0.06, P = 0.06, and P = 0.08, respectively). No complication attributable to intravitreal MTX occurred.
  
  
  CONCLUSIONS
  In this study, intravitreal injection of MTX resulted in anatomical improvement in a significant proportion of eyes with persistent DME. Significant visual improvement was found in 16.6 % of eyes.
authors.affiliation: Eye research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Sattarkhan-Niayesh Street, Tehran, 14456-13131, Iran. drghasemi@yahoo.com.
authors.forename: Khalil Ghasemi
authors.initials: KG
authors.lastname: Falavarjani
authors.affiliation: Eye research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Sattarkhan-Niayesh Street, Tehran, 14456-13131, Iran.
authors.forename: Sara
authors.initials: S
authors.lastname: Golabi
authors.affiliation: Eye research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Sattarkhan-Niayesh Street, Tehran, 14456-13131, Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Modarres
mesh_terms: D003930:Diabetic Retinopathy / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D058449:Intravitreal Injections; D008266:Macula Lutea / Q000473:pathology; D008269:Macular Edema / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D008727:Methotrexate / Q000008:administration & dosage*; D011446:Prospective Studies; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D007166:Immunosuppressive Agents; D008727:Methotrexate
keywords: Diabetic macular edema; Methotrexate; Optical coherence tomography