PURPOSE: To ascertain the effect of treatment with methotrexate (MTX) on the visual prognosis of birdshot chorioretinopathy (BSCR). METHODS: Retrospective case series of 76 consecutive patients with HLA-A29-positive BSCR, of whom 46 were followed for at least 5 years and 18 for longer than 10 years. A review of the medical records of 76 patients with BSCR. Treatment regimens were subdivided into the following groups: 1) No systemic immunomodulatory treatment; 2) Treatment with systemic corticosteroids; and 3) Treatments which comprised MTX. First, we calculated eye-years for the different therapeutic regimens and second, we subdivided the patients according to their initial treatment regimen and assessed visual outcomes. RESULTS: Mean visual acuity increased over time in the MTX-treated patients; remained unchanged in patients on systemic corticosteroids and decreased in the patients without systemic treatment (yearly change in LogMar -0.020, -0.034 and 0.028 with P = 0.034, P = 0.71 and P = 0.006 respectively). In the group treated initially with MTX, VA gradually increased in contrast to the remaining groups of patients (P = 0.003). CONCLUSION: In this series, treatment comprising MTX showed better visual outcomes than the untreated patients and corticosteroid-based treatment regimens.
PURPOSE: To ascertain the effect of treatment with methotrexate (MTX) on the visual prognosis of birdshot chorioretinopathy (BSCR). METHODS: Retrospective case series of 76 consecutive patients with HLA-A29-positive BSCR, of whom 46 were followed for at least 5 years and 18 for longer than 10 years. A review of the medical records of 76 patients with BSCR. Treatment regimens were subdivided into the following groups: 1) No systemic immunomodulatory treatment; 2) Treatment with systemic corticosteroids; and 3) Treatments which comprised MTX. First, we calculated eye-years for the different therapeutic regimens and second, we subdivided the patients according to their initial treatment regimen and assessed visual outcomes. RESULTS: Mean visual acuity increased over time in the MTX-treated patients; remained unchanged in patients on systemic corticosteroids and decreased in the patients without systemic treatment (yearly change in LogMar -0.020, -0.034 and 0.028 with P = 0.034, P = 0.71 and P = 0.006 respectively). In the group treated initially with MTX, VA gradually increased in contrast to the remaining groups of patients (P = 0.003). CONCLUSION: In this series, treatment comprising MTX showed better visual outcomes than the untreated patients and corticosteroid-based treatment regimens.
Authors: Evangelos Minos; Robert J Barry; Sue Southworth; Annie Folkard; Philip I Murray; Jay S Duker; Pearse A Keane; Alastair K Denniston Journal: Orphanet J Rare Dis Date: 2016-05-12 Impact factor: 4.123