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Intravitreal methotrexate as an adjuvant in vitrectomy in cases of retinal detachment with proliferative vitreoretinopathy
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Intravitreal methotrexate as an adjuvant in vitrectomy in cases of retinal detachment with proliferative vitreoretinopathy
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Journal Article
Intravitreal methotrexate as an adjuvant in vitrectomy in cases of retinal detachment with proliferative vitreoretinopathy
2025
Overview
Purpose
To compare the rate of re-detachment in patients with rhegmatogenous retinal detachment and Grade-C PVR following vitreoretinal surgery, with and without serial intravitreal injections of methotrexate.
Methods
It was a randomized control trial. Patients aged more than 18 years undergoing pars plana vitrectomy for rhegmatogenous retinal detachment with PVR grade C or more were included in the study. Patients treated with intravitreal injection of methotrexate were grouped as cases and those not injected served as controls. The cases received 3 intravitreal injections of methotrexate at monthly intervals. Patients were evaluated on Day 1, 1st month, 2nd month, 3rd month and 6th month in terms of BCVA, rate of re-attachment and grade of PVR.
Results
The case group had 23 patients and the control group had 20 patients. 2 patients in the case group were lost to follow-up after the first follow-up, so they were excluded. So 21 patients in case group and 20 patients in control group were followed up. Six months after surgery, 15 ‘cases’ had completely attached retina whereas 6 patients had partial detachment with macula on. There was no patient amongst the cases with macula-off retinal re-detachment. Out of 20 patients in the control group, 9 had a complete retinal attachment, 4 had partial detachment with macula-on and 7 had partial detachment with macula-off. There was statistically significant difference in macula off retinal detachment rates (
p
-value- 0.003).
Conclusion
Serial intravitreal methotrexate injections reduce the incidence of re-detachment in patients undergoing PPV for RRD with PVR-C. Further investigation into this promising therapeutic approach is warranted.
Key messages
What is known
Methotrexate is an anti-inflammatory agent which is safe for intravitreal use
There are case series retrospective and prospective studies suggesting potential benefit of intravitreal methotrexate in preventing re-detachment due to PVR
What is new
First randomized control trial studying the efficacy of intravitreal methotrexate in preventing re-detachment due to PVR
Our study showed statistically significant difference in macula off retinal detachment between the 2 groups at 6 months of follow up
Publisher
Springer Berlin Heidelberg,Springer Nature B.V
Subject
/ Aged
/ Female
/ Humans
/ Immunosuppressive Agents - administration & dosage
/ Male
/ Medicine
/ Methotrexate - administration & dosage
/ Retina
/ Retinal Detachment - complications
/ Retinal Detachment - diagnosis
/ Retinal Detachment - etiology
/ Retinal Detachment - surgery
/ Retinal Detachment - therapy
/ Surgery
/ Vitreoretinopathy, Proliferative - complications
/ Vitreoretinopathy, Proliferative - diagnosis
/ Vitreoretinopathy, Proliferative - drug therapy
