Low-Dose Intravitreal Methotrexate for Proliferative Vitreoretinopathy

Abstract

Background and Objective: Proliferative vitreoretinopathy (PVR) has been mitigated by intravitreal methotrexate (MTX) 400 μg/0.1 mL in several studies. Here, we evaluate the results from a lower dose of MTX, 200 μg/0.05 mL. Materials and Methods: We identified and reviewed records of patients with grade ≥C1 PVR who were treated with 200 μg/0.05 mL MTX injections: during PVR surgery and every 2 weeks thereafter. Results: Twenty-four eyes met inclusion criteria with a mean of 5.6 injections and follow-up ranging 6 to 56 months. The retina was reattached in 19 of 24 eyes (79%) after a single surgery and in 5 of 24 eyes (21%) after one additional PVR surgery. Visual acuity improved from baseline logMAR 1.63 to 0.97 at 12 months ( P < .001), with 5 of 20 achieving 20/60 or better and 16 of 20 achieving 20/200 or better. One eye developed a transient corneal abrasion that resolved within 1 week. Conclusion: Low-dose MTX (200 μg/0.05 mL) during and after PVR surgery resulted in good rates of retinal reattachment and visual acuity recovery. [ Ophthalmic Surg Lasers Imaging Retina 2023;54(3):139–146.]

Intravitreal Methotrexate for the Treatment and Prevention of Proliferative Vitreoretinopathy in Pediatric Patients

“…24 Ullah et al achieved an attachment rate of 79% following an average of 5.6 injections in patients with severe PVR. 14 Nourinia et al achieved a retina reattachment rate of 100% posterior to the equator in 11 eyes treated with intravitreal methotrexate. 18 Roca et al reported a statistically significant difference in attachment rates in those who received methotrexate vs the control group.…”

“…Benner et al reported on five patients with PVR and recurrent RD treated with five serial low-dose intravitreal MTX injections with a 100% attachment rate 24. Ullah et al achieved an attachment rate of 79% following an average of 5.6 injections in patients with severe PVR 14. Nourinia et al achieved a retina reattachment rate of 100% posterior to the equator in 11 eyes treated with intravitreal methotrexate 18.…”

Intravitreal Methotrexate for the Treatment and Prevention of Proliferative Vitreoretinopathy in Pediatric Patients

“…24 Ullah et al achieved an attachment rate of 79% following an average of 5.6 injections in patients with severe PVR. 14 Nourinia et al achieved a retina reattachment rate of 100% posterior to the equator in 11 eyes treated with intravitreal methotrexate. 18 Roca et al reported a statistically significant difference in attachment rates in those who received methotrexate vs the control group.…”

“…Benner et al reported on five patients with PVR and recurrent RD treated with five serial low-dose intravitreal MTX injections with a 100% attachment rate 24. Ullah et al achieved an attachment rate of 79% following an average of 5.6 injections in patients with severe PVR 14. Nourinia et al achieved a retina reattachment rate of 100% posterior to the equator in 11 eyes treated with intravitreal methotrexate 18.…”

The Role of Systemic Methotrexate on Preventing Proliferative Vitreoretinopathy Following Retinal Detachment Repair

“…Several recent studies have demonstrated the benefit from use of IVT MTX when it is delivered repeatedly in the early postoperative period to eyes at high risk for reproliferation. 9,10,[17][18][19][20][21][22] In a large retrospective cohort study, postoperative IVT MTX was associated with fewer reoperation and better visual outcome compared to controls. 18 Ullah et al 22 demonstrated in a prospective pilot study that low-dose IVT MTX administered via repeated injections during vitrectomy and biweekly postop-eratively may reduce PVR recurrence in patients with existing grade ≥ C1 PVR and evaluated the rate of retinal reattachment.…”

“…MTX continues to be explored as a treatment option to mitigate the incidence of PVR post RD repair. Several recent studies have demonstrated the benefit from use of IVT MTX when it is delivered repeatedly in the early postoperative period to eyes at high risk for reproliferation 9,10,17–22. In a large retrospective cohort study, postoperative IVT MTX was associated with fewer re-operation and better visual outcome compared to controls 18.…”

“…In a large retrospective cohort study, postoperative IVT MTX was associated with fewer re-operation and better visual outcome compared to controls 18. Ullah et al22 demonstrated in a prospective pilot study that low-dose IVT MTX administered via repeated injections during vitrectomy and biweekly postoperatively may reduce PVR recurrence in patients with existing grade ≥ C1 PVR and evaluated the rate of retinal reattachment. Similarly, Nourinia et al10 explored repeated IVT MTX in patients with grade C PVR and noted trends toward improved anatomical outcomes, although statistical significance in functional recovery was not observed.…”

Intravitreal Methotrexate for the Treatment and Prevention of Proliferative Vitreoretinopathy in Pediatric Patients

“…24 Ullah et al achieved an attachment rate of 79% following an average of 5.6 injections in patients with severe PVR. 14 Nourinia et al achieved a retina reattachment rate of 100% posterior to the equator in 11 eyes treated with intravitreal methotrexate. 18 Roca et al reported a statistically significant difference in attachment rates in those who received methotrexate vs the control group.…”

“…Benner et al reported on five patients with PVR and recurrent RD treated with five serial low-dose intravitreal MTX injections with a 100% attachment rate 24. Ullah et al achieved an attachment rate of 79% following an average of 5.6 injections in patients with severe PVR 14. Nourinia et al achieved a retina reattachment rate of 100% posterior to the equator in 11 eyes treated with intravitreal methotrexate 18.…”

The Role of Systemic Methotrexate on Preventing Proliferative Vitreoretinopathy Following Retinal Detachment Repair

“…Several recent studies have demonstrated the benefit from use of IVT MTX when it is delivered repeatedly in the early postoperative period to eyes at high risk for reproliferation. 9,10,[17][18][19][20][21][22] In a large retrospective cohort study, postoperative IVT MTX was associated with fewer reoperation and better visual outcome compared to controls. 18 Ullah et al 22 demonstrated in a prospective pilot study that low-dose IVT MTX administered via repeated injections during vitrectomy and biweekly postop-eratively may reduce PVR recurrence in patients with existing grade ≥ C1 PVR and evaluated the rate of retinal reattachment.…”

“…MTX continues to be explored as a treatment option to mitigate the incidence of PVR post RD repair. Several recent studies have demonstrated the benefit from use of IVT MTX when it is delivered repeatedly in the early postoperative period to eyes at high risk for reproliferation 9,10,17–22. In a large retrospective cohort study, postoperative IVT MTX was associated with fewer re-operation and better visual outcome compared to controls 18.…”

“…In a large retrospective cohort study, postoperative IVT MTX was associated with fewer re-operation and better visual outcome compared to controls 18. Ullah et al22 demonstrated in a prospective pilot study that low-dose IVT MTX administered via repeated injections during vitrectomy and biweekly postoperatively may reduce PVR recurrence in patients with existing grade ≥ C1 PVR and evaluated the rate of retinal reattachment. Similarly, Nourinia et al10 explored repeated IVT MTX in patients with grade C PVR and noted trends toward improved anatomical outcomes, although statistical significance in functional recovery was not observed.…”

Intravitreal Methotrexate for the Treatment and Prevention of Proliferative Vitreoretinopathy in Pediatric Patients

“…24 Ullah et al achieved an attachment rate of 79% following an average of 5.6 injections in patients with severe PVR. 14 Nourinia et al achieved a retina reattachment rate of 100% posterior to the equator in 11 eyes treated with intravitreal methotrexate. 18 Roca et al reported a statistically significant difference in attachment rates in those who received methotrexate vs the control group.…”

“…Benner et al reported on five patients with PVR and recurrent RD treated with five serial low-dose intravitreal MTX injections with a 100% attachment rate 24. Ullah et al achieved an attachment rate of 79% following an average of 5.6 injections in patients with severe PVR 14. Nourinia et al achieved a retina reattachment rate of 100% posterior to the equator in 11 eyes treated with intravitreal methotrexate 18.…”

The Role of Systemic Methotrexate on Preventing Proliferative Vitreoretinopathy Following Retinal Detachment Repair

“…Several recent studies have demonstrated the benefit from use of IVT MTX when it is delivered repeatedly in the early postoperative period to eyes at high risk for reproliferation. 9,10,[17][18][19][20][21][22] In a large retrospective cohort study, postoperative IVT MTX was associated with fewer reoperation and better visual outcome compared to controls. 18 Ullah et al 22 demonstrated in a prospective pilot study that low-dose IVT MTX administered via repeated injections during vitrectomy and biweekly postop-eratively may reduce PVR recurrence in patients with existing grade ≥ C1 PVR and evaluated the rate of retinal reattachment.…”

“…MTX continues to be explored as a treatment option to mitigate the incidence of PVR post RD repair. Several recent studies have demonstrated the benefit from use of IVT MTX when it is delivered repeatedly in the early postoperative period to eyes at high risk for reproliferation 9,10,17–22. In a large retrospective cohort study, postoperative IVT MTX was associated with fewer re-operation and better visual outcome compared to controls 18.…”

“…In a large retrospective cohort study, postoperative IVT MTX was associated with fewer re-operation and better visual outcome compared to controls 18. Ullah et al22 demonstrated in a prospective pilot study that low-dose IVT MTX administered via repeated injections during vitrectomy and biweekly postoperatively may reduce PVR recurrence in patients with existing grade ≥ C1 PVR and evaluated the rate of retinal reattachment. Similarly, Nourinia et al10 explored repeated IVT MTX in patients with grade C PVR and noted trends toward improved anatomical outcomes, although statistical significance in functional recovery was not observed.…”