The use of low dose methotrexate in children with chronic anterior and intermediate uveitis

Aim: To assess the efficacy of low dose methotrexate (MTX) therapy for children with chronic anterior and intermediate uveitis. Methods: A retrospective case review of 10 children who received MTX for chronic uveitis at a tertiary referral centre was performed. The following data were recorded for each patient: age, sex, race, duration of uveitis, primary diagnosis, anatomical localisation of uveitis, corticosteroid therapy, dose range of MTX, duration of MTX therapy, and side effects of MTX therapy. Several clinical parameters were evaluated to study the effect of MTX. These included visual acuity, anterior chamber inflammation, and topical and oral corticosteroid requirement. Results: After MTX VA of 6/6 or better was present in 100% right eyes and 80% left eyes ( p = 0.055 and p = 0.016, respectively). Anterior chamber inflammation decreased in 60% of children after MTX ( p = 0.0168). The requirement of topical steroid decreased from a mean of 5.6 times a day before MTX to 1.5 times a day after MTX ( p = 0.005). The dose of oral steroid decreased from a mean of 18 mg per day to 2.85 mg per day ( p = 0.012). The most common adverse effect was nausea ( 20%). No patient required discontinuation of MTX because of side effects. Conclusion: MTX is effective and safe for chronic anterior and intermediate uveitis in children. An increase awareness of its efficacy is required among paediatricians and ophthalmologists to prevent sight threatening complication of chronic uveitis and its treatment with long term use of steroids.