Methotrexate treatment for sarcoid-associated panuveitis

Objective: To determine the safety and efficacy of low-dose methotrexate (M TX) for sarcoid-associated panuveitis. Design: Retrospective noncomparative case series. Participants: Twenty eyes from 11 patients were analyzed. Eight patients ha d sarcoidosis, Three patients were clinically suspected of sarcoidosis desp ite negative laboratory testing. All charts of patients with sarcoidosis an d idiopathic uveitis seen by the Duke Uveitis Service from 1989 to 1997 wer e retrospectively reviewed. Those with sarcoid-associated or sarcoid-suspec ted panuveitis treated with MTX with a minimum of 6 months of follow-up wer e 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 requi rements, anterior chamber inflammation, and ability to undergo successful c ataract extraction were used to measure the efficacy of MTX therapy. Results: After MTX treatment was initiated, 90% of eyes had preserved or im proved 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 compl etely 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 corticosteroi ds were decreased in 63% of eyes. The mean initial use was once every 1.6 h ours, and the mean final use was once every 3.9 hours (P = 0.001). Ninety-f ive percent of eyes had stabilized or decreased inflammation. The mean init ial 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 o f uncontrolled inflammation became quiet on MIX and underwent surgery. One hundred percent of these eyes had improved vision after surgery. Side effec ts were mild and transient or reversible. Conclusion: Low-dose MTX is an effective and safe adjunct to treat chronic sarcoid-associated panuveitis.