Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands.
Retina. 2011 Jun;31(6):1150-5. doi: 10.1097/IAE.0b013e3181ff0d8f.
To ascertain the effect of treatment with methotrexate (MTX) on the visual prognosis of birdshot chorioretinopathy (BSCR).
Retrospective case series of 76 consecutive patients with HLA-A29-positive BSCR, of whom 46 were followed for at least 5 years and 18 for longer than 10 years. A review of the medical records of 76 patients with BSCR. Treatment regimens were subdivided into the following groups: 1) No systemic immunomodulatory treatment; 2) Treatment with systemic corticosteroids; and 3) Treatments which comprised MTX. First, we calculated eye-years for the different therapeutic regimens and second, we subdivided the patients according to their initial treatment regimen and assessed visual outcomes.
Mean visual acuity increased over time in the MTX-treated patients; remained unchanged in patients on systemic corticosteroids and decreased in the patients without systemic treatment (yearly change in LogMar -0.020, -0.034 and 0.028 with P = 0.034, P = 0.71 and P = 0.006 respectively). In the group treated initially with MTX, VA gradually increased in contrast to the remaining groups of patients (P = 0.003).
In this series, treatment comprising MTX showed better visual outcomes than the untreated patients and corticosteroid-based treatment regimens.
确定甲氨蝶呤（MTX）治疗对鸟枪弹样脉络膜视网膜病变（BSCR）的视觉预后的影响。
回顾性连续 76 例 HLA-A29 阳性 BSCR 患者的病例系列，其中 46 例至少随访 5 年，18 例随访时间超过 10 年。回顾分析 76 例 BSCR 患者的病历。治疗方案分为以下几组：1）无全身免疫调节治疗；2）全身皮质类固醇治疗；3）包括 MTX 的治疗方案。首先，我们计算了不同治疗方案的眼年数，其次，我们根据初始治疗方案将患者细分，并评估了视力结果。
MTX 治疗组的视力随着时间的推移而逐渐提高；全身皮质类固醇治疗组的视力保持不变，无全身治疗组的视力下降（每年 LogMar 变化分别为-0.020、-0.034 和 0.028，P = 0.034、P = 0.71 和 P = 0.006）。在最初接受 MTX 治疗的组中，VA 逐渐增加，而其余组患者的 VA 则下降（P = 0.003）。
在本系列中，包括 MTX 的治疗方案与未治疗患者和基于皮质类固醇的治疗方案相比，显示出更好的视力结果。
