Intra-silicone oil injection of methotrexate at the end of vitrectomy for advanced proliferative diabetic retinopathy

Abstract

Purpose To evaluate the role of methotrexate (MTX) injected into the silicone oil at the end of pars plana vitrectomy for advanced proliferative diabetic retinopathy (PDR). Methods In this prospective comparative interventional study, eyes with severe diabetic tractional macular detachment or combined tractional/rhegmatogenous retinal detachment were included. Standard 20 gauge pars plana vitrectomy, and retinal reattachment was performed. In the case group, 250 μg MTX was injected into the silicone oil at the end of surgery. The rate of retinal re-detachment associated with fibrovascular proliferation or proliferative vitreoretinopathy (PVR) was assessed. Results Overall, 38 eyes of 35 patients (19 cases and 19 controls) were studied. The two groups were matched for age, sex, preoperative visual acuity, and the type of surgery (vitrectomy alone vs combined phacoemulsification/vitrectomy). Retinal re-detachment with fibrovascular proliferation or PVR occurred in seven eyes (36.8%) in the MTX group and eight eyes (42.1%) in the control group (P = 0.74). Mean change in visual acuity was 0.04 ± 0.71 and 0.39 ± 0.70 logMAR in the MTX and the control group, respectively (P = 0.14). The rate of improvement or worsening of visual acuity was similar between the two groups (P = 0.51 and P = 0.12). Conclusion Intra-silicone injection of MTX at the end of vitrectomy for retinal detachment associated with severe PDR did not reduce the risk of postoperative retinal detachment due to the fibrous or fibrovascular proliferations.

Intravitreal methotrexate infusion for proliferative vitreoretinopathy

“…We hypothesize that IMI might be an effective adjuvant to reduce PVR incidence even among eyes without a history of PVR. While a recent report found that addition of MTX to the silicone oil tamponade after retina reattachment did not prevent recurrent detachment in diabetic retinopathy, 14 the MTX concentrations used were lower than this study and the method of MTX application may limit the access of the drug to the retina. Also, the ability of MTX to induce remission in uveitis suggests that the drug could be particularly efficacious in PVR associated with ocular inflammation.…”

“…A recent report included 250 µg of MTX in the silicon oil tamponade instilled at the end of retinal reattachment surgery in advanced diabetic retinopathy patients without significant adverse effects; however, clinical efficacy in preventing recurrent RD in diabetic retinopathy was not observed. 14 …”

Intravitreal methotrexate for the treatment of proliferative vitreoretinopathy

“…Ghasemi Falavarjani et al injected a single dose of MTX (250 µg) into 19 silicone oil filled eyes undergoing repair of a diabetic tractional or combined rhegmatogenous retinal detachment and 19 matched control eyes. The single injection of MTX did not reduce the rate of PVR-induced recurrent RD in this study 4…”

Migration of Silicone Oil into the Orbit and Eyelid as a Cyst

“…Silicone oil is used to treat complex vitreoretinal diseases such as proliferative diabetic retinopathy, retinal detachment, and severe eye trauma [9][10][11][12].…”