KMID : 0213520230370060446
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Korean Journal of Ophthalmology 2023 Volume.37 No. 6 p.446 ~ p.452
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Effects of Subcutaneous Methotrexate in Patients with Refractory Uveitis and Chorioretinitis
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Lee Sang-Hyup
Choo Hun-Gu Kwon Oh-Woong You Yong-Sung
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Abstract
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Purpose: Methotrexate (MTX) is an immunosuppressive agent used to treat noninfectious inflammatory eye conditions and is generally administered orally for ocular inflammatory diseases. When used in rheumatological diseases, subcutaneous administration has been reported to show higher efficacy than oral administration. Therefore, this study aimed to evaluate the effect of subcutaneous MTX in patients with refractory uveitis or choroiditis who did not respond to other immunosuppressive agents.
Methods: A retrospective case series study was performed between January and December 2018. Patients with uveitis or chorioretinitis who showed little to no treatment response for 6 months or more with conventional immunosuppressive agents were treated with MTX, administered subcutaneously. After 6 months of treatment, patients were evaluated to determine whether complete suppression of inflammation sustained for ¡Ã28 days was achieved in both eyes and whether improvement can be confirmed by fluorescein angiography (FAG).
Results: Subcutaneous MTX treatment was performed on 18 patients: 11 had intermediate uveitis and seven had posterior uveitis. In the intermediate uveitis patient group, five patients (50% of the group excluding one patient who dropped out) showed improvement in FAG and three patients (30%) showed complete suppression of inflammation. In the posterior uveitis group, two out of seven patients (excluding two patients who dropped out) showed an improvement, two patients in the group showed little change, and one patient showed aggravation of FAG findings.
Conclusions: The study confirmed that in patients with uveitis or chorioretinitis who had a refractory response to treatment with other immunosuppressive agents, subcutaneous MTX showed improved treatment efficacy.
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KEYWORD
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Immunosuppressive agents, Refractory choroiditis, Refractory uveitis, Subcutaneous methotrexate
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