Author: Alan Franklin (United States)
Co-authors: Athanasios Nikolakopoulos, Christopher Riemann, Lauren Gibson
Purpose
Fibrous and glial proliferation is one the largest surgical challenges that present to retinal specialists. Studies have indicated a potential role for postoperative intravitreal methotrexate after previous failed retinal detachment surgery. We included previously unoperated eyes at high risk for failure because of pre-existing advanced proliferative vitreoretinopathy or diabetic retinopathy.
Setting/Venue
This is a retrospective review of outcomes in a private practice setting in eyes with advanced proliferative diabetic retinopathy, trauma associated pathology, or proliferative vitreoretinopathy. Outcome measures are examined and compared amongst patients with or without postoperative intravitreal methotrexate injectrions.
Methods
This is a retrospective chart review of patients who underwent retinal detachment surgery for the following reasons: 1) Failed previous retinal reattachment surgery, 2) Advanced Proliferative Diabetic Retinopathy, 3) Initial surgery for retinal detachment associated with trauma, or 4) Primary retinal detachments associated with Grade C proliferative vitreoretinopathy. Methotrexate, 200µg, was administered intravitreally via the inferotemporal par plana at post op weeks 1, 2, 4, 7, and 11. Data including reoperation rate, visual acuity, physical exam, and OCT biomarkers were analyzed.
Results
A total number of 112 eyes were evaluated in this study. 14 eyes received intravitreal methotrexate and 98 eyes did not. The average number of re-operations among eyes treated with methotrexate was 0.57, compared to an average number of 1.12 among those who did not, p < 0.05. Many eyes had previously underwent multiple operations for proliferative vitreoretinopathy, and required no further operations after postoperative intravitreal methotrexate. Similarly, many patients with advanced proliferative diabetic retinopathy who required surgery in both eyes required less operations in the eyes that received postoperative intravitreal methotrexate compared to the fellow eye that was not injected. On exam, eyes injected with methotrexate had less postoperative epiretinal membrane proliferation compared to uninjected eye. Initial analysis also suggests a trend in better visual acuity for eyes that underwent intravitreal methotrexate. OCT biomarker analysis is pending.
Conlusions
We report that 5 postoperative intravitreal injections of methotrexate reduce reoperation rates in both eyes that have failed previous retinal reattachment surgery and eyes that are higher risk to fail primary surgery because of advanced proliferative vitreoretinopathy or diabetic retinopathy. Less postoperative epiretinal membrane formation is also evident in eyes injected with methotrexate.
Financial Disclosure
Alcon Consultant and Grant Support AclepiX Consultant Scanoptix Consultant ForwardVue Pharma Founder
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