Methotrexate for chronic non-necrotizing anterior scleritis in Chinese patients

Abstract

AIM: To evaluate the effectiveness and corticosteroid-sparing capabilities of methotrexate (MTX) in the treatment of chronic non-necrotizing anterior scleritis in Chinese patients. METHODS: A retrospective chart review of all patients with active anterior scleritis between January 2015 and June 2019 was conducted. All patients received 10 to 15 mg/wk MTX orally, and corticosteroids (10 to 40 mg/d prednisolone or equivalent methylprednisolone) with slow tapering. Topical corticosteroid eye drops (1% prednisolone actate, 0.1% dexmathosone or 0.1% fluoromethalone) were applied to control comorbid anterior uveitis at presentation or during follow up. The main outcomes were inflammation control and corticosteroid-sparing success, and secondary outcomes were reduction of immunosuppression load and best-corrected visual acuity (BCVA). RESULTS: Thirty-two eyes (22 patients) were included. The proportion of patients who achieved corticosteroid-sparing success was 50.0% at 3mo and 77.3% at 12mo [8 (36.4%) patients discontinued corticosteroid]. The proportion of eyes that achieved inflammation control was 59.4% at 3mo and 78.1% at 12mo. The immunosuppression load was 5.14±0.87 at presentation and 2.76±2.34 at 12mo (P<0.01). BCVA maintained unchanged or improved in 29 (90.6%) of all affected eyes. One patient discontinued MTX treatment because of an abnormal liver function test, and no other serious adverse effects were observed. CONCLUSION: According to this pilot study, low dose MTX appear to be a well-tolerated and effective treatment for chronic non-necrotizing anterior scleritis patients in the Chinese population.

Treatment of uveitis and scleritis patients in Malaysia

“…It is noteworthy that contrary to other published studies, aetiologies such as Birdshot chorioretinopathy, onchocerciasis, toxocariasis, Lyme disease, and presumed ocular histoplasmosis syndrome (POHS) were not seen in our population. It is well-known that the aetiology for uveitis varied depending upon epidemiology, geographical, climate variation, and disease dissemination, hence some diseases are not frequently encountered in our part of the world [13][14][15][16][17][18][19][20][21][22][23][24][25] . Herpetic iridocyclitis was the commonest infectious aetiology in our study, similar to Singapore [30] , Thailand [29] , Taiwan China [7] , Japan [32] , and Italy [18] .…”

“…Early diagnosis and timely treatment of uveitis and scleritis are imperative to reduce the risk of visual impairment [8,13] . Epidemiology of ocular inflammation is considerably diverse worldwide and various factors influence it which include host, environmental, genetic, ethnic, socioeconomic, and demographic factors [1][2]6,8,[10][11][13][14][15][16][17][18][19][20][21][22][23][24][25] . A better understanding of the demographic and causes of uveitis and scleritis in various geographic areas will prevent unnecessary laboratory testing, and the delay in commencing treatment [4] .…”

Intravitreal injection of methotrexate in persistent diabetic macular edema: a 6-month study

“…Methotrexate (MTX) is administered to treat various malignant tumors and autoimmune diseases. Intravitreal injection of 400 µg MTX is used for eye pathologies associated with inflammation-driven macular edema [ 11 , 12 ] . It has both antineoplastic and anti-inflammatory properties and inhibits the enzyme dihydrofolate reductase, which is necessary for folate synthesis.…”

“…It has both antineoplastic and anti-inflammatory properties and inhibits the enzyme dihydrofolate reductase, which is necessary for folate synthesis. This inhibition leads to a decrease in DNA synthesis and cell proliferation [ 11 ] . Additionally, MTX inhibits leukocyte chemotaxis and the secretion of tumor necrosis factor-alpha, interleukin-8, and interleukin-6 by monocytes.…”