Methotrexate therapy for chronic noninfectious uveitis - Analysis of a case series of 160 patients

Purpose: To evaluate the outcomes of patients with chronic noninfectious uv eitis unresponsive to conventional antiinflammatory therapy who were treate d with methotrexate. Design: Retrospective noncomparative interventional case series. Participants: All patients with chronic noninfectious uveitis treated with methotrexate at a single institution from 1985 to 1999, Methods: Charts of patients seen on the Ocular Immunology & Uveitis Service at the Massachusetts Eye & Ear Infirmary were reviewed. Patients with chro nic uveitis of noninfectious origin treated with methotrexate were included in the study. Main Outcome Measures: Control of inflammation, steroid-sparing effect, vis ual acuity, adverse reactions. Results: A total of 160 patients met the inclusion criteria, Control of inf lammation was achieved in 76.2% of patients. Steroid-sparing effect was ach ieved in 56% of patients, Visual acuity was maintained or improved in 90% o f patients. Side effects requiring discontinuation of medication occurred i n 18% of patients, Potentially serious adverse reactions occurred in only 8 .1% of patients. There was neither long-term morbidity nor mortality caused by methotrexate. Conclusions: Methotrexate is effective in the treatment of chronic noninfec tious uveitis that fails to respond to conventional steroid treatment. It i s an effective steroid-sparing immunomodulator, is a safe medication, and i s well tolerated. Ophthalmology 2001;108:1134-1139 (C) 2001 by the American Academy of Ophthalmology.