Outcome of Intravitreal Methotrexate in the Treatment of Uveitis and Uveitic Cystoid Macular Edema: A Case Series from a Tertiary Care Hospital in Lahore

Abstract

Background: Uveitis is an important cause of preventable visual morbidity. In non-infectious disease, corticosteroids and systemic immunomodulatory therapy remain central to management, but treatment-related toxicity and the need for targeted ocular therapy have encouraged interest in local drug delivery. Intravitreal methotrexate has been used as a local anti-inflammatory treatment for selected cases of uveitis and uveitic cystoid macular edema (CME), although contemporary evidence remains limited and heterogeneous.

Objective: To determine the outcome of intravitreal methotrexate in the treatment of uveitis and uveitic cystoid macular edema.

Methods: This single-centre interventional case series was conducted at the Department of Ophthalmology, Jinnah Hospital, Lahore, from 2 January to 1 July 2023. Sixty-five eyes of 65 patients aged 40–70 years with uveitis or uveitic CME were enrolled by non-probability consecutive sampling. Each study eye received a single intravitreal injection of methotrexate 400 µg/0.1 mL. Best-corrected visual acuity (BCVA; Snellen decimal notation) and central macular thickness (CMT; optical coherence tomography) were assessed at baseline and 12 weeks. Baseline and 12-week measurements were compared as paired observations; subgroup comparisons of 12-week outcomes were exploratory. A p-value <0.05 was considered statistically significant.

Results: Mean age was 55.20 ± 6.02 years; 36 patients (55.38%) were male. Mean BCVA increased from 0.30 ± 0.03 at baseline to 0.59 ± 0.04 at 12 weeks (mean change +0.29; p<0.001), while mean CMT decreased from 407.34 ± 27.74 µm to 263.05 ± 12.19 µm (mean change −144.29 µm; p<0.001). Exploratory subgroup analysis showed higher 12-week BCVA in patients aged 56–70 years, those with symptom duration >6 months, and those without diabetes mellitus. Daily computer use >6 hours was associated with lower 12-week CMT. Other subgroup comparisons were not statistically significant.

Conclusion: In this case series, a single intravitreal methotrexate injection was associated with substantial short-term improvement in BCVA and reduction in CMT at 12 weeks. Because the study was uncontrolled and subgroup analyses were exploratory, comparative effectiveness, durability, safety, and treatment-effect modifiers require confirmation in controlled studies.