Methotrexate treatment for sarcoid-associated panuveitis

Area of Science:

• Ophthalmology
• Rheumatology
• Immunology

Background:

• Sarcoid-associated panuveitis is a chronic inflammatory condition affecting the eye.
• Management often requires immunosuppressive therapy to control inflammation and preserve vision.

Purpose of the Study:

• To evaluate the safety and efficacy of low-dose methotrexate (MTX) as a treatment for sarcoid-associated panuveitis.

Main Methods:

• Retrospective case series analyzing 20 eyes from 11 patients with sarcoidosis or suspected sarcoidosis.
• Patients received weekly low-dose MTX with at least 6 months of follow-up.
• Efficacy assessed by visual acuity, corticosteroid requirements, inflammation levels, and cataract surgery outcomes.

Main Results:

• 90% of eyes showed preserved or improved visual acuity; mean visual acuity improved from 20/62 to 20/40.
• Oral corticosteroid dosage decreased by 100% in all patients and was discontinued in 86%.
• Inflammation stabilized or decreased in 95% of eyes, with significant reductions in both oral and topical corticosteroid use.
• Five eyes previously unsuitable for cataract surgery due to inflammation became quiet on MTX and achieved improved vision post-surgery.
• Reported side effects were mild and transient or reversible.

Conclusions:

• Low-dose methotrexate is a safe and effective adjunctive therapy for chronic sarcoid-associated panuveitis.
• MTX helps control ocular inflammation, reduce corticosteroid dependency, and improve visual outcomes.
• This treatment facilitates surgical interventions like cataract extraction in previously inflamed eyes.