Paraneoplastic acute exudative polymorphous vitelliform maculopathy improved with intravitreal methotrexate

Area of Science:

• Ophthalmology
• Retinal Diseases
• Oncology

Background:

• Acute exudative polymorphous vitelliform maculopathy (AEPVM) is a rare retinal disorder.
• It can be idiopathic or associated with malignancies.
• The pathogenesis involves an immune attack on the retinal pigment epithelium (RPE) and photoreceptors.

Observation:

• A case of paraneoplastic AEPVM in a 58-year-old man with metastatic melanoma is presented.
• The patient's condition was refractory to oral prednisone, intravitreal bevacizumab, and intravitreal preservative-free triamcinolone.
• Intravitreal methotrexate therapy was administered.

Findings:

• Intravitreal methotrexate led to improved vision in the patient.
• Resolution of subfoveal fluid was observed following methotrexate treatment.
• This suggests a potential benefit of methotrexate in managing AEPVM.

Implications:

• Intravitreal methotrexate may be a viable treatment for AEPVM.
• It is particularly considered when standard therapies like steroids and anti-VEGF agents are ineffective.
• Further research is warranted to confirm the efficacy and safety of methotrexate for AEPVM.