Intraocular methotrexate for epithelial downgrowth: Long-term outcomes in a multicentre case series Journal Article


Authors: Hébert, M.; Kyrillos, R.; Snyder, M. E.; Mackool, R. J.; Francis, J. H.; Wu, H. K.; Riemann, C. D.; Légaré, M. E.
Article Title: Intraocular methotrexate for epithelial downgrowth: Long-term outcomes in a multicentre case series
Abstract: Background/Aims Sheet-like type of epithelial downgrowth (EDG) is not easily amenable to surgical excision. We describe long-term outcomes in patients with EDG treated with intraocular methotrexate (MTX). Methods This is a retrospective, multicentric case series including 10 eyes (nine patients) treated with intraocular MTX for sheet-like EDG. Relevant ocular history, previous EDG treatments, MTX injection regimen, long-term outcomes and complications are reported. Results All cases were associated with intraocular surgery. Most patients were treated with 400 μm/0.1 mL MTX injections with a starting frequency of two times per week or weekly injections. Mean and SD number of injections per eye was 16±13 injections and duration of follow-up was 54±36 months (range: 7-120 months). Eradication of EDG was achieved in seven eyes of which one required a second MTX treatment course to achieve eradication, while clinical resolution with recurrence was observed in two. One treatment failure occurred despite eight weekly injections which slowed but did not halt EDG progression; the patient later requested that treatments be stopped given difficulty to come to follow-ups. Surface epitheliopathy developed in eight patients and was used to titrate MTX treatment. Six patients also developed endothelial failure. Conclusion We report the largest case series of diffuse, sheet-like EDG treated with intraocular MTX with follow-ups up to 10 years. Intraocular MTX may be used effectively to achieve eradication of EDG in cases where surgery is not amenable. However, further recommendations to guide treatment remain warranted. © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords: treatment outcome; retrospective studies; clinical trial; methotrexate; retrospective study; injection; multicenter study; eye; injections; trauma; drugs; cornea; humans; human; treatment medical; treatment surgery
Journal Title: British Journal of Ophthalmology
Volume: 107
Issue: 9
ISSN: 0007-1161
Publisher: BMJ Publishing Group Ltd.  
Date Published: 2023-09-01
Start Page: 1383
End Page: 1389
Language: English
DOI: 10.1136/bjophthalmol-2022-321168
PUBMED: 35649694
PROVIDER: scopus
PMCID: PMC10977087
DOI/URL:
Notes: Article -- Source: Scopus
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  1. Jasmine Helen Francis
    257 Francis