Abstract
Purpose :
Oral (PO) MTX is commonly used for the treatment of inflammatory uveitis, but has not been studied in preventing proliferative vitreoretinopathy (PVR). We aim to determine whether PO MTX, dosed 10-15 mg weekly with daily folic acid supplementation, decreases the risk of PVR development and rate of redetachment.
Methods :
A multi-center retrospective series involving both an academic institute and a large private practice. Selection criteria included patients with rhegmatogenous retinal detachments (RRD) who met high risk characteristics including 1 ≥ of the following: recurrent detachments, detachments involving > 2 quadrants, extensive vitreous hemorrhage, retinal tears > 2 clock hours, active uveitis/post globe repair, or chronic subretinal fluid for over 2 months duration. 11 patients met the above qualifications. All patients were started on 10 mg PO MTX each week and daily folic acid on post-op day 1. Surgeries included pars plana vitrectomy (PPV) or PPV + scleral buckle (SB) with either C3F8 gas or silicone oil (SO). Patients were maintained on MTX each week for at least 6 months.
Results :
11/11 patients have remained attached, quiet on exam, and have not required additional surgery. 7/11 patients had SO placed. 3/7 SO patients underwent SO removal at the time of reporting. 5/11 patients have had at least 3 recurrent RRDs, requiring at least 3 surgeries before starting MTX but have remained attached following their third surgery while on MTX. 4/11 of phakic patients underwent cataract surgery. 5/11 patients had final BCVA of ≥ 20/40.
Conclusions :
This multi-center study suggests that a 6+ month course of low dose PO MTX with folic acid supplementation may help prevent PVR and re-detachment in those with high-risk characteristics, particularly in patients who have detached multiple times. Oral MTX may serve as a good alternative to intravitreal MTX in preventing PVR and recurrent detachments. MTX is economically feasible, easier to obtain compared to intravitreal MTX, and is less stressful to deliver to the patient.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.