Treatment of Chronic Central Serous Chorioretinopathy with Oral Methotrexate

To evaluate the effects of oral methotrexate (MTX) in patients with chronic central serous chorioretinopathy (CSC).

This is an interventional, prospective uncontrolled clinical trial, which included 23 eyes of 23 consecutive patients presenting with chronic symptomatic CSC and persistent subretinal fluid (SRF) for longer than 3 months. All patients were treated with 7.5 mg/week of oral MTX for 12 weeks. The best corrected visual acuity (BCVA), central macular thickness (CMT), SRF, and total macular volume recorded by monthly optical coherence tomography were analyzed. Complete blood count and serum liver enzymes level were monitored.

Mean duration of CSC was 13 months (3-36 months). Mean BCVA improved from 20/40 at baseline to 20/30 at the third month and 20/28 at the sixth month (P=0.002 and 0.003, respectively). Mean CMT decreased from 375 μm at baseline to 278 μm and 265 μm at the third and sixth month (P=0.002 and 0.007, respectively). Mean total macular volume decreased from 9.33 mm(3) at baseline to 8.48 and 8.31 mm(3) at the third and sixth month (P=0.001 and 0.001, respectively). Thirteen (62%) eyes achieved complete resolution of SRF. No MTX-associated toxicity was detected.

Low-dose oral MTX may be an alternative therapeutic option for the treatment of chronic CSC. This study paves the way for a randomized clinical trial comparing the effects of MTX treatment with photodynamic therapy or observation.