Department of Ophthalmology, Nune Eye Hospital, Seoul, Korea.
Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea.
Korean J Ophthalmol. 2023 Dec;37(6):446-452. doi: 10.3341/kjo.2023.0073. Epub 2023 Oct 25.
Methotrexate (MTX) is an immunosuppressive agent used to treat noninfectious inflammatory eye conditions and is generally administered orally for ocular inflammatory diseases. When used in rheumatological diseases, subcutaneous administration has been reported to show higher efficacy than oral administration. Therefore, this study aimed to evaluate the effect of subcutaneous MTX in patients with refractory uveitis or choroiditis who did not respond to other immunosuppressive agents.
A retrospective case series study was performed between January and December 2018. Patients with uveitis or chorioretinitis who showed little to no treatment response for 6 months or more with conventional immunosuppressive agents were treated with MTX, administered subcutaneously. After 6 months of treatment, patients were evaluated to determine whether complete suppression of inflammation sustained for ≥28 days was achieved in both eyes and whether improvement can be confirmed by fluorescein angiography (FAG).
Subcutaneous MTX treatment was performed on 18 patients: 11 had intermediate uveitis and seven had posterior uveitis. In the intermediate uveitis patient group, five patients (50% of the group excluding one patient who dropped out) showed improvement in FAG and three patients (30%) showed complete suppression of inflammation. In the posterior uveitis group, two out of seven patients (excluding two patients who dropped out) showed an improvement, two patients in the group showed little change, and one patient showed aggravation of FAG findings.
The study confirmed that in patients with uveitis or chorioretinitis who had a refractory response to treatment with other immunosuppressive agents, subcutaneous MTX showed improved treatment efficacy.
甲氨蝶呤（MTX）是一种免疫抑制剂，用于治疗非传染性炎症性眼病，通常口服用于眼部炎症性疾病。在风湿性疾病中，皮下给药已被报道比口服给药具有更高的疗效。因此，本研究旨在评估在对其他免疫抑制剂无反应的难治性葡萄膜炎或脉络膜炎患者中，皮下给予 MTX 的疗效。
这是一项 2018 年 1 月至 12 月进行的回顾性病例系列研究。对经常规免疫抑制剂治疗 6 个月以上炎症反应改善不明显或无改善的葡萄膜炎或脉络膜炎患者，给予 MTX 皮下注射治疗。治疗 6 个月后，评估患者双眼炎症是否完全抑制且持续≥28 天，以及荧光素眼底血管造影（FAG）是否可确认改善。
18 例患者接受了 MTX 皮下治疗：11 例为中间葡萄膜炎，7 例为后葡萄膜炎。在中间葡萄膜炎患者组中，5 例（除 1 例退出患者外，该组的 50%）FAG 改善，3 例（30%）炎症完全抑制。在后葡萄膜炎组中，7 例患者中有 2 例（除 2 例退出患者外）改善，2 例无明显变化，1 例 FAG 发现加重。
本研究证实，在对其他免疫抑制剂治疗有难治性反应的葡萄膜炎或脉络膜炎患者中，皮下给予 MTX 可提高治疗效果。
