Intraocular Methotrexate Can Induce Extended Remission in Some Patients in Noninfectious Uveitis

Taylor, Simon; Banker, Alay; Schlaen, Ariel; Couto, Cristóbal; Matthé, Egbert; Joshi, Lavnish; Menezo, Víctor; Nguyen, Ethan; Tomkins-Netzer, Oren; Bar, Asaf; Morarji, Jiten; McCluskey, Peter; Lightman, Sue

doi:10.1097/iae.0b013e31828ac07d

Cited by 79 publications

(48 citation statements)

References 34 publications

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“…14,15 Previous studies have reported potent antiinflammatory properties of the intravitreal MTX in patients with noninfectious uveitis. 16,17 Moreover, intravitreal injection of MTX has less complication compared with the triamcinolone acetonide, another potent widely used anti-inflammatory agent. 9 Two studies reported the use of intra-silicone MTX for surgical indications other than intraocular lymphoma.…”

Section: Discussionmentioning

confidence: 99%

Intra-silicone oil injection of methotrexate at the end of vitrectomy for advanced proliferative diabetic retinopathy

Falavarjani

Modarres

Hadavandkhani

et al. 2015

Eye

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Purpose To evaluate the role of methotrexate (MTX) injected into the silicone oil at the end of pars plana vitrectomy for advanced proliferative diabetic retinopathy (PDR). Methods In this prospective comparative interventional study, eyes with severe diabetic tractional macular detachment or combined tractional/rhegmatogenous retinal detachment were included. Standard 20 gauge pars plana vitrectomy, and retinal reattachment was performed. In the case group, 250 μg MTX was injected into the silicone oil at the end of surgery. The rate of retinal re-detachment associated with fibrovascular proliferation or proliferative vitreoretinopathy (PVR) was assessed. Results Overall, 38 eyes of 35 patients (19 cases and 19 controls) were studied. The two groups were matched for age, sex, preoperative visual acuity, and the type of surgery (vitrectomy alone vs combined phacoemulsification/vitrectomy). Retinal re-detachment with fibrovascular proliferation or PVR occurred in seven eyes (36.8%) in the MTX group and eight eyes (42.1%) in the control group (P = 0.74). Mean change in visual acuity was 0.04 ± 0.71 and 0.39 ± 0.70 logMAR in the MTX and the control group, respectively (P = 0.14). The rate of improvement or worsening of visual acuity was similar between the two groups (P = 0.51 and P = 0.12). Conclusion Intra-silicone injection of MTX at the end of vitrectomy for retinal detachment associated with severe PDR did not reduce the risk of postoperative retinal detachment due to the fibrous or fibrovascular proliferations.

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Section: Discussionmentioning

confidence: 99%

Intra-silicone oil injection of methotrexate at the end of vitrectomy for advanced proliferative diabetic retinopathy

Falavarjani

Modarres

Hadavandkhani

et al. 2015

Eye

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“…Has an excellent safety profile when injected into the eye Single 400 lg/0.1 mL dose : visual acuity in 79 % of treated eyes and ; the need for systemic therapy; in patients that relapsed after the first injection, a second injection was followed by remission of up to 18 months [25] Sirolimus Subconjunctival (1320 lg) and intravitreal (352 lg) injections at days 0, 60 and 120 appeared to be safe and well tolerated, and : visual acuity, ; inflammation and ; the need for systemic corticosteroids [26] Bimonthly 440 lg injections ; vitreous haze (primary endpoint) in 60 % of patients [27] IOP intraocular pressure, : increase(d)/improved, ; decrease(d) the treatment of choice for ameliorating signs and symptoms of sight-threatening ocular inflammation (Fig. 1); however, their use is limited by their well-known adverse event profiles.…”

Section: Intermediate and Posterior Uveitis Often Requires An Aggressmentioning

confidence: 98%

Manage non-infectious uveitis in adults with individualized immunosuppressive therapy and regular monitoring

Writers

2016

Drugs Ther Perspect

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“…A more recent paper described a multicenter, retrospective interventional case series of patients with non-infectious uveitis treated with intravitreal MTX [55]. Thirty-eight eyes of 30 patients were enrolled, for a total of 54 intravitreal injections of MTX at a dose of 400 mg in 0.1 ml.…”

Section: Intravitreal Mtxmentioning

confidence: 99%

Review of the latest local treatments for uveitis

Bhat

Goldstein

2014

Expert Review of Ophthalmology

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There have been many recent advances in local therapeutic options for uveitis, both corticosteroid and non-corticosteroid. Long-and short-acting steroid implants are now available, with new ones being developed. There are also new locations for drug delivery (suprachoroidal space) and new non-corticosteroid options. This paper reviews the data on the currently available local treatment options, as well as those currently under investigation. The choice of local therapy depends on whether or not there is systemic inflammatory disease also requiring treatment, if the disease is unilateral or bilateral, expected disease duration, patient preference and co-existing ocular and systemic comorbidities. For chronic disease without systemic manifestations, long-term steroid releasing implants are a good option, whereas for breakthrough inflammation and cystoid macular edema, short-term intravitreal therapy, initially with corticosteroids then with alternative agents is considered.

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Intraocular Methotrexate Can Induce Extended Remission in Some Patients in Noninfectious Uveitis

Cited by 79 publications

References 34 publications

Intra-silicone oil injection of methotrexate at the end of vitrectomy for advanced proliferative diabetic retinopathy

Intra-silicone oil injection of methotrexate at the end of vitrectomy for advanced proliferative diabetic retinopathy

Manage non-infectious uveitis in adults with individualized immunosuppressive therapy and regular monitoring

Review of the latest local treatments for uveitis

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