Pilot study of safety and effect of combined intravitreal bevacizumab and methotrexate for neovascular age-related macular degeneration

PURPOSE. To evaluate the safety and effect of combined intravitreal methotrexate and bevacizumab on choroidal neovascularization in age-related macular degeneration (AMD). METHODS. Seven eyes of 7 patients (4 female; mean age 65.43 +/- 5.96 years) with choroidal neovascularization secondary to AMD were studied. Patients received intravitreal injection of methotrexate and bevacizumab and were examined every 1.5 months. Reinjections were performed with bevacizumab only. RESULTS. Three patients had 3 months, 3 had 4.5 months, and 1 had 8 months of follow-up. Mean number of reinjections was 2.0. In all patients, best-corrected visual acuity (BCVA) improved compared to baseline. Central macular thickness (CMT) decreased in all but one patient who had no reduced visual acuity. Mean BCVA (logMAR) was 1.27 +/- 0.43 D at baseline, 1.1 +/- 0.38 D at week 6, and 0.93 +/- 0.31 D at month 3. Mean BCVA in 3 patients at 4.5 months was 1.1 +/- 0.15 D. There were statistically significant differences between BCVA before injection and at week 6 (p=0.017), 3 months (p=0.005), and 4.5 months (p=0.04). Mean baseline CMT was 389 +/- 177 mu m, 371 +/- 154 mu m at 6 weeks, and 317 +/- 108 mu m at 3 months. Mean CMT in 3 patients at 4.5 months was 266 +/- 66 mu m. There were no statistically significant differences between baseline CMT and after treatment. No scar formation, increase of scar, or adverse reaction to methotrexate injection were seen. CONCLUSIONS. Addition of intravitreal methotrexate to bevacizumab was safe in 7 eyes of 7 patients. It may enhance the therapeutic effect in regression of neovascularization in AMD and may reduce development of a fibrous component and disciform scar formation.