Shree K. Kurup (Winston Salem, NC, USA), Armando Oliver, Andres Emanuelli, Vincent Hau, David Callanan (San Juan, Puerto Rico)


Chronic central serous chorioretinopathy (CSR) is a condition that may be difficult to manage with conventional therapy or “off-label” therapy. Methotrexate is a relatively inexpensive drug that is available almost everywhere. Oral metronomic methotrexate (MTX) was considered in eight selected CSR cases that had no viable alternatives.


Eight patients with chronic recalcitrant CSR were evaluated for secondary methods of treatment. Metronomic doses of MTX (oral) were prescribed at 0.01 – 0.025 mg/kg/wk along with folic acid supplementation. Follow-up examinations included visual acuity measurement, clinical findings and retinal imaging.

Effectiveness / Safety:

VA improved in 8 eyes (73%) and remained unchanged in 2 (18%). Mean improvement was 3 lines when compared to baseline (p =0.02). Mean baseline central macular thickness (CMT) by OCT was 274µm with a range of 16 -475µm. At the final visit mean CMT was 244µm (range 119 – 645 µm) (p = 0.33). Mean baseline macular volume (MV) by OCT was 7.94 mm3 with a range of 6.65 – 10.90 mm3.  At final visit mean MV was 6.96 mm3 (range 5.43 – 8.10 mm3) (p = 0.025). None of the patients in our study developed systemic or ocular complications associated to the oral MTX medication.

Take home message:

It appears that in this small group of patients’ metronomic MTX therapy coincided with an improvement in VA, MV and a trend towards decreased CMT in 8 eyes. Some of these patients had CSR over many years. The association between improvement and metronomic MTX therapy may justify investigating MTX in larger patient cohort.