Evaluation of Therapeutic Effect of Intravitreal Injection of Methotrexate in Persistent Diabetic Macular Edema

Purpose: To evaluate the therapeutic Effect of Intravitreal Injection of Methotrexate in patient with Persistent Diabetic Macular Edema. Methods: 33 eyes of 30 patients with macular edema, who did not respond to three successive injections of Avastin, in an interval of six to four weeks, were included in the study. Patients underwent full ocular examinations and macular OCT. Each case was injected to a 400μg of methotrexate at 0.16 cc. follow up was made in the 1, 3, and 6 months after injection, and each time a full examination and macular OCT was performed. Results: Patients included 13 females and 17 males with an average age of 62.79±8.33 years old. The mean duration of diabetes was 17.07±6.85 Years. The mean MT (macular thickness) before injection of methotrexate was 369.82±71.66 and at the end of the follow up (month 6) was 364.33±77.3μm (P=0.194). The mean changes of MT before injection compared to 6 months after injection was 5.485±10.985. The mean of CST (centeral subfield thickness) was 490.03±101.18 before the injection and 446.52±166.42 μm (P = 0.014) at the end of the follow-ups. The mean of CST changes from the before injection was recorded as 43±515±24.365, compared to 6 months after the injection. Significant reduced CST was seen in the last month (month 6) compared to CST before injection in 24 eyes (72.7%).The mean of visual acuity before treatment was 0.597±0.334 LogMAR and 0.714±0.516 at month 6. (P = 0.394). The mean changes in BCVA compared to months 6 which were calculated to be 0.134±0.064 LogMAR. Conclusion: intraocular injection of methotrexate was not effective in the treatment of persistent diabetic macular edema.