Elsevier

Ophthalmology

Volume 106, Issue 1, 1 January 1999, Pages 111-118
Ophthalmology

Methotrexate treatment for sarcoid-associated panuveitis

Presented in part at the American Academy of Ophthalmology annual meeting, San Francisco, California, October 1997.
https://doi.org/10.1016/S0161-6420(99)90011-8Get rights and content

Abstract

Objective

To determine the safety and efficacy of low-dose methotrexate (MTX) for sarcoid-associated panuveitis.

Design

Retrospective noncomparative case series.

Participants

Twenty eyes from 11 patients were analyzed. Eight patients had sarcoidosis. Three patients were clinically suspected of sarcoidosis despite negative laboratory testing. All charts of patients with sarcoidosis and idiopathic uveitis seen by the Duke Uveitis Service from 1989 to 1997 were retrospectively reviewed. Those with sarcoid-associated or sarcoid-suspected panuveitis treated with MTX with a minimum of 6 months of follow-up were studied.

Intervention

Low-dose MTX was administered to patients weekly and patients were followed with serial ophthalmologic and medical examinations.

Main outcome measures

Visual acuity, oral and topical corticosteroid requirements, anterior chamber inflammation, and ability to undergo successful cataract extraction were used to measure the efficacy of MTX therapy.

Results

After MTX treatment was initiated, 90% of eyes had preserved or improved visual acuity. Mean initial Snellen visual acuity was 20/62 and mean final acuity was 20/40 (P = 0.044). Of those patients initially requiring oral corticosteroids, the dosage was decreased in 100%, and they were completely discontinued in 86%. The mean initial oral corticosteroid dose was 26.6 mg and the mean final dose was 1.5 mg (P = 0.012). Topical corticosteroids were decreased in 63% of eyes. The mean initial use was once every 1.6 hours, and the mean final use was once every 3.9 hours (P = 0.001). Ninety-five percent of eyes had stabilized or decreased inflammation. The mean initial inflammation score was 1.2, and the mean final score was 0.5 (P = 0.007). Five of six eyes previously unable to have cataract extraction because of uncontrolled inflammation became quiet on MTX and underwent surgery. One hundred percent of these eyes had improved vision after surgery. Side effects were mild and transient or reversible.

Conclusion

Low-dose MTX is an effective and safe adjunct to treat chronic sarcoid-associated panuveitis.

Section snippets

Methods

Two hundred seventy-four consecutive charts of patients with the diagnosis of either sarcoidosis or unspecified uveitis (which included choroiditis, chorioretinitis, retinal pigment epithelial inflammation, iridocyclitis, pars planitis, posterior uveitis, vasculitis, and panuveitis) examined by one of us (GJJ) in the Duke Uveitis clinic from 1989 to 1997 were reviewed. Those with sarcoid-associated panuveitis or idiopathic panuveitis with a clinical suspicion of sarcoidosis who were treated

Results

After chart review, 11 patients meeting the aforementioned inclusion criteria were identified and analyzed. All 11 patients studied suffered from bilateral panuveitis. Two eyes had no light perception vision initially and were not included in any of the analyses. A third eye had no light perception vision develop during the study and was enucleated. This eye was included in visual acuity result comparisons (20 eyes total from 11 patients) but excluded in comparisons for topical corticosteroid

Discussion

In our series, we report the successful use of low-dose MTX in 11 patients (20 eyes) with chronic sarcoid-associated panuveitis. All of the patients in our study suffered from bilateral disease. To our knowledge, there are only two series of low-dose MTX in the management of ocular inflammatory disease.20, 21 In 1992, Holz et al20 reported MTX treatment in a cohort of 14 total patients with a mixture of diagnoses, including vasculitis, panuveitis, and intermediate uveitis. Outcomes for specific

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    1

    Dr. Dev is a recipient of the Heed Ophthalmic Foundation Fellowship and is currently affiliated with the Medical College of Wisconsin Eye Institute, Vitreoretinal Section, Milwaukee, Wisconsin.

    2

    Dr. Jaffe is a Lew R. Wasserman Merit Award recipient from Research to Prevent Blindness.

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