*The two authors made an equal contribution to this work.
A 13-year-old male and a 15-year-old female presented with optic disc edema associated with chronic recurrent uveitis. While the ocular inflammation responded to high doses of oral prednisolone, the disc edema showed little improvement. After oral administration of methotrexate, the disc edema and ocular inflammation were resolved, and the dose of oral corticosteroid could be reduced.
Optic disc edema or papillitis is commonly associated with chronic anterior uveitis in children, and its prevalence has been reported to be 21% [
A 13-year-old male patient presented with bilateral optic disc edema accompanied by idiopathic chronic anterior uveitis that had been ongoing for two months. At that time, his visual acuity was 20 / 25 in the right eye and 20 / 40 in the left eye, and there was no macula edema on funduscopic examination or optical coherence tomography. He had been taking 30 mg (0.52 mg/kg) of oral prednisolone daily. We could not find any neurologic or systemic abnormalities to explain the disc edema. For six months, he had taken oral prednisolone and could not taper it due to the recurrence of ocular inflammation. In addition, the disc edema had not subsided, even with a high dose of oral prednisolone (60 mg [1.05 mg/kg] per day). Thereafter, we added oral methotrexate 10 mg (0.18 mg/kg) per week to the daily dose of prednisolone 30 mg (0.52 mg/kg). After 3 weeks of methotrexate, the disc edema and ocular inflammation were alleviated, and his vision improved to 20 / 20 in both eyes (
A 15-year-old female patient presented with optic disc edema in the right eye and bilateral idiopathic panuveitis (
Optic disc edema from various causes may result in irreversible axonal damage and progressive visual field loss [
For long-term treatment with methotrexate, caution should be exercised regarding the systemic and ocular side effects. Elevated liver enzymes, nausea, fatigue, cytopenia, stomatitis, bone marrow suppression and liver cirrhosis have been reported as systemic side effects of methotrexate [
In our cases of steroid-refractory uveitic optic disc edema in children, methotrexate had a beneficial effect on the resolution of optic disc edema and controlled intraocular inflammation while sparing the corticosteroid. We are unaware of previous reports showing the efficacy of methotrexate reducing recalcitrant uveitic disc edema in children. Therefore, we think that this report is a significant reference regarding the effect of methotrexate in the treatment of pediatric uveitis accompanying disc edema.
No potential conflict of interest relevant to this article was reported.
Case 1. Fundus photographs of case 1. (A,B) At presentation, bilateral severe disc edema and vascular tortuosity were observed. (C,D) Three weeks after administration of methotrexate, disc edema and vascular tortuosity were resolved.
Case 2. A fundus photograph (A) and fluorescein angiography (B) of the right eye revealing disc edema and choroiditis. (C,D). One month after administration of methotrexate, the disc edema and fluorescein leakage from the optic disc were resolved.