Postoperative Methotrexate to Reduce Reoperation Rate and Improve Vision in Patients With Complex Retinal Detachments,Advanced Diabetic Retinopathy,and Trauma

Abstract

Purpose: To identify the potential benefits of postoperative intravitreal (IVT) methotrexate (MTX) for proliferative vitreoretinopathy (PVR), trauma, or advanced diabetic retinopathy (DR). Methods: A retrospective chart review was performed of previously unoperated eyes at high risk for failure as a result of preexisting PVR, trauma, or advanced DR. Patients were included who had retinal detachment (RD) surgery for the following reasons: failed previous retinal reattachment surgery, advanced proliferative DR (PDR), initial surgery for RD associated with trauma, or primary RD associated with grade C PVR. MTX 200 to 400 µg was administered intravitreally at postoperative weeks 1, 2, 4, 7, and 11. Data analyzed included the reoperation rate, visual acuity (VA), physical examination findings, and optical coherence tomography biomarkers. Results: Of the 255 eyes evaluated, 94 received IVT MTX (MTX group) and 161 eyes did not (control group). The mean number of reoperations was 0.39 in the MTX group and 0.94 in the control group (P < .01). The MTX group had a mean gain in VA of 1 line, while the control group had a mean loss of 2.9 lines (P < .01). Conclusions: Postoperative IVT MTX in eyes with advanced PDR or complicated RD yields comparable effective results, including reduced reoperation rates and improved VA.