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

Advantages:

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.

Methods:

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.