Intravitreal methotrexate for the treatment of choroidal neovascularization in multifocal choroiditis

Abstract

Sir, Intravitreal methotrexate for the treatment of choroidal neovascularization in multifocal choroiditisWe describe a case of a patient who developed a multifocal choroiditis complicated with a choroidal neovascular (CNV) membrane, and propose an intravitreal methotrexate therapy as a treatment option that can improve vision and eliminate all inflammatory signs. Case reportA healthy 25-year-old woman presented with evidence of a multifocal choroiditis (MFC) complicated with a

Phase IIb clinical trial of ranibizumab for the treatment of uveitic and idiopathic choroidal neovascular membranes

“…The specific role of inflammation in the pathogenesis of iCNV is also supported from other histological studies and the response observed following treatment of iCNV with immunosuppressive agents 5 6 9 10. Before anti-VEGFs were available, corticosteroids were the first-line treatment for iCNV and, in particular, corticosteroids in addition to PDT were more effective than PDT alone 25.…”

“…There are also some anecdotal reports of the use of other therapeutic agents such as intravitreal methotrexate9 and oral sirolimus 10…”

Use of Methotrexate for the Treatment of Ocular Inflammation and Uveitis

“…MTX therapy is indicated in almost all types of ocular inflammation, including anterior, intermediate, posterior, and panuveitis, retinal vasculitis, scleritis, childhood chronic uveitis, and mucus membrane pemphigoid [17][18][19]. Other specific indications include Behçet disease [20], birdshot chorioretinopathy [21], multifocal choroiditis with panuveitis [22,23], sarcoidosis [24], Vogt-Koyanagi-Harada disease [25], and sympathetic ophthalmia [26]. In addition, complications In pediatric patients, corticosteroid use is associated with a potential risk of irreversible growth suppression despite the presence of human growth hormones [31].…”

“…In addition, MTX can be administered intravitreally at a dose of 400 μg in 0.1 mL. Recently, several studies have shown that intravitreal injection of MTX is effective for the treatment of uveitis with no serious ocular side effects [20,23,[36][37][38]. Intravitreal administration can be advantageous because it can avoid the potential side effects of systemic corticosteroids and immunosuppressive agents, especially in patients with unilateral uveitis.…”

“…Intravitreal administration can be advantageous because it can avoid the potential side effects of systemic corticosteroids and immunosuppressive agents, especially in patients with unilateral uveitis. Thus, intravitreal administration can be a promising route of administration for patients who are vulnerable to associated with chronic uveitis such as macular edema, choroidal neovascularization, and optic disc edema can be improved with MTX [23,27,28].…”