Corneal Epithelial Toxicity after Intravitreal Methotrexate Injection for Vitreoretinal Lymphoma: Clinical and In Vitro Studies

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ID: 111172
2020
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Abstract
Methotrexate is widely used as an intraocular chemotherapy for vitreoretinal lymphoma (VRL). Although corneal toxicity has been reported in patients after intravitreal methotrexate injections, the incidence, outcome, and mechanism of the toxicity are unclear. Herein, we performed a clinical study to evaluate the incidence, predisposing factors, and treatment outcome of corneal epitheliopathy associated with intravitreal methotrexate injection. In addition, we directly investigated cytotoxic effects and mechanisms of methotrexate in cultures of human corneal epithelial cells (CECs). Medical chart reviews revealed that corneal epitheliopathy occurred in 15 eyes (22.7%, 12 patients) out of 66 eyes (45 patients) after intravitreal methotrexate injections for treatment of VRL. The use of topical anti-glaucoma medication was significantly associated with development of corneal epitheliopathy. The epitheliopathy resolved in all patients 2.4 months after onset. In culture, methotrexate decreased the survival of CECs by inducing apoptosis, increasing oxidative stress, suppressing proliferation, and upregulating inflammatory cytokines. The addition of folinic acid significantly protected the cells from the methotrexate-induced toxicity. Hence, our results suggest that care should be taken to minimize the contact of methotrexate with corneal epithelium during injection, and folic or folinic acid supplementation might be beneficial for preventing corneal complications in patients undergoing intravitreal methotrexate injections.
Reference Key
jeong2020journalcorneal Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Yoon Jeong;Jin Suk Ryu;Un Chul Park;Joo Youn Oh;Jeong, Yoon;Ryu, Jin Suk;Park, Un Chul;Oh, Joo Youn;
Journal journal of clinical medicine
Year 2020
DOI
10.3390/jcm9082672
URL
https://www.mdpi.com/2077-0383/9/8/2672
Keywords
apoptosis folic acid corneal epithelium methotrexate folinic acid vitreoretinal lymphoma National Center for Biotechnology Information NCBI NLM MEDLINE pubmed abstract nih national institutes of health national library of medicine pmid:32824794 pmc7463496 doi:10.3390/jcm9082672 yoon jeong jin suk ryu joo youn oh

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