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Use of methotrexate in sarcoid-associated optic neuropathy
Heather A Maust1, Rod Foroozan, Robert C Sergott
1Neuro-Ophthalmology Service, Jefferson Medical College, Thomas Jefferson University, Wills Eye Hospital, 900 Walnut Street, Philadelphia, PA 19107, USA.
Objective:
To demonstrate the possible beneficial effects of methotrexate (MTX) therapy for patients with sarcoid-associated optic neuropathy (SAON).
Design:
Retrospective, noncomparative, interventional case series.
Participants:
Three patients diagnosed with SAON who received MTX. Two patients had tissue biopsies consistent with sarcoidosis, and 1 patient had clinically diagnosed sarcoidosis based on laboratory and radiographic studies. All 3 patients developed side effects with corticosteroid treatment of their optic neuropathy.
Intervention:
Patients were treated with weekly doses of oral MTX and monitored with neuro-ophthalmic, medical, and laboratory examinations.
Main Outcome Measures:
Visual acuity, automated perimetry, and reduction of oral prednisone therapy.
Results:
After initiation of MTX, all 3 patients showed an improvement or stabilization of visual acuity. All patients had a decrease in their corticosteroid requirements, and all had improved or stabilized visual field deficits. One of the 3 patients developed leukopenia that necessitated a reduction of the methotrexate dose.
Conclusion:
Methotrexate may be effective for SAON as an adjunct to corticosteroid therapy or as an alternative for corticosteroid-intolerant patients. Oral MTX reduced the corticosteroid requirements of 3 patients with SAON, and all 3 demonstrated stable or improved visual function.