Malik A R, Pavesio C
East Surrey Hospital, Redhill, UK.
Br J Ophthalmol. 2005 Jul;89(7):806-8. doi: 10.1136/bjo.2004.054239.
To assess the efficacy of low dose methotrexate (MTX) therapy for children with chronic anterior and intermediate uveitis.
A retrospective case review of 10 children who received MTX for chronic uveitis at a tertiary referral centre was performed. The following data were recorded for each patient: age, sex, race, duration of uveitis, primary diagnosis, anatomical localisation of uveitis, corticosteroid therapy, dose range of MTX, duration of MTX therapy, and side effects of MTX therapy. Several clinical parameters were evaluated to study the effect of MTX. These included visual acuity, anterior chamber inflammation, and topical and oral corticosteroid requirement.
After MTX VA of 6/6 or better was present in 100% right eyes and 80% left eyes (p = 0.055 and p = 0.016, respectively). Anterior chamber inflammation decreased in 60% of children after MTX (p = 0.0168). The requirement of topical steroid decreased from a mean of 5.6 times a day before MTX to 1.5 times a day after MTX (p = 0.005). The dose of oral steroid decreased from a mean of 18 mg per day to 2.85 mg per day (p = 0.012). The most common adverse effect was nausea (20%). No patient required discontinuation of MTX because of side effects.
MTX is effective and safe for chronic anterior and intermediate uveitis in children. An increase awareness of its efficacy is required among paediatricians and ophthalmologists to prevent sight threatening complication of chronic uveitis and its treatment with long term use of steroids.
评估低剂量甲氨蝶呤（MTX）治疗儿童慢性前葡萄膜炎和中间葡萄膜炎的疗效。
对一家三级转诊中心接受MTX治疗慢性葡萄膜炎的10名儿童进行回顾性病例分析。记录每位患者的以下数据：年龄、性别、种族、葡萄膜炎病程、初步诊断、葡萄膜炎的解剖定位、皮质类固醇治疗、MTX剂量范围、MTX治疗持续时间以及MTX治疗的副作用。评估了几个临床参数以研究MTX的效果。这些参数包括视力、前房炎症以及局部和口服皮质类固醇的需求。
MTX治疗后，100%的右眼和80%的左眼视力达到6/6或更好（分别为p = 0.055和p = 0.016）。60%的儿童在MTX治疗后前房炎症减轻（p = 0.0168）。局部类固醇的需求从MTX治疗前的平均每天5.6次降至MTX治疗后的每天1.5次（p = 0.005）。口服类固醇的剂量从平均每天18毫克降至每天2.85毫克（p = 0.012）。最常见的不良反应是恶心（20%）。没有患者因副作用而需要停用MTX。
MTX对儿童慢性前葡萄膜炎和中间葡萄膜炎有效且安全。儿科医生和眼科医生需要提高对其疗效的认识，以预防慢性葡萄膜炎及其长期使用类固醇治疗引起的视力威胁性并发症。
