The role of intraocular methotrexate in the management of uveitis and posterior segment involvement in Behçet’s disease patients

IntroductionBehçet’s disease (BD) is a multisystem disorder that may be associated with systemic vasculitis, uveitis, retinal vasculitis, and optic neuropathy.Aim of this workTo evaluate the efficacy of intravitreal methotrexate (MTX) for the treatment of ocular posterior segment involvement in BD patients.Patients and methodsTwenty adult Behcet’s disease patients suffering from BD-associated ocular inflammation with posterior segment involvement were included in the present study. Disease activity was assessed using the Behcet’s Disease Current Activity Form (BDCAF) score. All patients underwent complete ophthalmologic examination, which included the best corrected visual acuity testing (VA), slit-lamp biomicroscopy, tonometry, and indirect ophthalmoscopy. Injection of 400 μg/0.1 ml of MTX intravitreally was done once monthly for 3 months.ResultsVisual acuity (initially 2.8 ± 2.03) significantly improved in 16 eyes (80%) at the 3- (4.3 ± 2.3) and 6-month (4.1 ± 1.3) (p = 0.02) follow-up examinations. During 6 months of follow up period after methotrexate treatment, the mean dose of corticosteroids decreased in all patients and two of nine patients receiving azathioprine were able to decrease the dose. Four eyes showed a galloping cataract following the injection with worsening of VA despite the improvement in posterior segment involvement as detected by ultrasonographic examination. Five eyes (25%) relapsed and the mean number of relapses decreased significantly after MTX injection (p = 0.01).ConclusionIntravitreal MTX can improve VA and reduce posterior segment manifestations in BD patients with posterior segment involvement, and may allow the reduction of corticosteroids and immunosuppressive drugs.