June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
Post-operative Intravitreal Methotrexate Injections after Recurrent Retinal Detachment Repair Can Reduce the Risk and Progression of Proliferative Vitreoretinopathy
Author Affiliations & Notes
  • Christianne April Wa
    Associated Retinal Consultants, Royal Oak, Michigan, United States
  • Lisa F Faia
    Associated Retinal Consultants, Royal Oak, Michigan, United States
  • Tamer H Mahmoud
    Associated Retinal Consultants, Royal Oak, Michigan, United States
  • Footnotes
    Commercial Relationships   Christianne Wa, None; Lisa Faia, None; Tamer Mahmoud, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 1413. doi:
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      Christianne April Wa, Lisa F Faia, Tamer H Mahmoud; Post-operative Intravitreal Methotrexate Injections after Recurrent Retinal Detachment Repair Can Reduce the Risk and Progression of Proliferative Vitreoretinopathy. Invest. Ophthalmol. Vis. Sci. 2020;61(7):1413.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Retinal detachments (RDs) and macular holes are vision threatening conditions that can lead to permanent vision loss if not repaired. Proliferative vitreoretinopathy (PVR) is a common complication that leads to surgical failure and redetachment. We hypothesized that treatment with intravitreal methotrexate (MTX) injections post-operatively can prevent and reduce the risk of PVR, increase reattachment rates, and improve visual outcomes. Secondly, we hypothesized that less than weekly treatment can still be safe and effective.

Methods : A retrospective, observational, clinical study was performed on patients aged 18 years and older with recurrent RDs and PVR, who were at high risk of developing postoperative PVR and received post-operative intravitreal MTX therapy. Outcome measures included visual acuity, retinal reattachment, course of PVR, and any adverse effects.

Results : Three patients with recurrent RDs and PVR underwent repeat pars plana vitrectomy (PPV). Patients #1 and #2 developed recurrent RDs despite scleral buckle surgery and intraocular silicone oil. Patient #3 developed an RD after macular hole repair. Each patient had at least two PPVs prior to reoperation, and thus the decision was made to start adjuvant intravitreal MTX therapy. Depending on surgeon preference, intravitreal MTX was administered intraoperatively. Otherwise, intravitreal MTX 400 mcg/ 0.1 mL injections were administered post-operatively on average every 13 days (range: 7-28 days). Average number of injections was 4.7 (range: 3-6 injections). Follow up duration ranged from 1 to 6 months (average: 3 days). Post-operative visual acuity was 20/40, 20/200, and HM respectively. There were no significant adverse effects. All three patients had surgical and anatomical success with improvement in vision and reattachment of the retina. Subretinal fluid resolved with no recurrence of PVR.

Conclusions : This pilot study demonstrates that post-operative intravitreal MTX injections administered almost every two weeks in patients with recurrent RDs at high risk of developing PVR can be effective in reducing the risk and progression of PVR and improving visual and surgical outcomes. Repeat treatments appear to be safe and effective, and adverse effects are minimal. These preliminary findings are promising as we strive to find a way to prevent PVR and restore vision.

This is a 2020 ARVO Annual Meeting abstract.

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