Repeated Injection of Methotrexate into Silicone Oil-Filled Eyes for Grade C Proliferative Vitreoretinopathy: A Pilot Study

Abstract

<b><i>Purpose:</i></b> To evaluate the effects of repeated intra-silicone oil (SO) injections of methotrexate (MTX) on the outcomes of surgery for rhegmatogenous retinal detachment (RRD) with grade C proliferative vitreoretinopathy (PVR-C). <b><i>Methods:</i></b> In this prospective pilot case series, eyes with RRD and PVR-C underwent pars plana vitrectomy and intraocular injection of SO. At the conclusion of the procedure, 250 µg of MTX was injected into the SO-filled vitreous cavity. Intra-SO injection was repeated at weeks 3 and 6; the minimum follow-up period was 6 months. The main outcome measure was retinal reattachment rate. <b><i>Results:</i></b> Eleven eyes of 11 patients (mean age, 52.73 ± 18.01 years) were included. The mean follow-up period was 9 ± 3 months (range, 6–15 months). Total retinal detachment with anterior and/or posterior PVR-C was present in all eyes before surgery. Mean preoperative best-corrected visual acuity (BCVA) was 2.62 ± 0.04 logMAR. All operated eyes exhibited retinal reattachment posterior to the equator during the follow-up period. Mean postoperative BCVA was significantly improved to 1.02 ± 0.51 logMAR (<i>p</i> = 0.003). No ocular or systemic side effects were observed. <b><i>Conclusion:</i></b> Repeated intra-SO injection of MTX as an adjunctive therapy for RRD complicated by PVR showed promising results and was not associated with adverse effects. Further studies are needed to confirm its possible beneficial effects on the final anatomic and functional outcomes in these cases.

Sustained dasatinib treatment prevents early fibrotic changes following ocular trauma

“…Maintaining effective concentration is an important factor for prevention of PVR with other drugs as well. Recent studies using methotrexate for the prevention of recurrent PVR demonstrate that, while a single injection at the time of corrective surgery failed to show statistically significant difference in retinal re-detachment rate compared to control [ 29 ], no re-detachment was observed in two separate pilot studies when drug presence was sustained in eyes by repeated intraocular injection [ 30 , 31 ].…”

Pharmacotherapy as an adjunct to vitrectomy

“…24 However, more recent case series have demonstrated an excellent safety profile with no significant adverse reaction observed. [25][26][27] A recent retrospective cohort study was performed to evaluate the effects of repeated intrasilicone oil injections of methotrexate on the outcomes of surgery for rhegmatogenous retinal detachment with grade C PVR. 28 Eleven subjects were included in the study with a mean follow-up of 3 months.…”

“…Other recent studies with intravitreal methotrexate for PVR have had positive anatomical and visual outcomes. 25,26 Antiproliferative agents Antiproliferative drugs have also been used in the treatment of PVR to control the mitogenic activity of cells at the vitreoretinal interface. A recent prospective noncomparative case series that evaluated 16 consecutive eyes with perforating choroidal injury was performed to investigate the potential role of mitomycin C in preventing PVR in eyes with open globe trauma.…”

“… 24 However, more recent case series have demonstrated an excellent safety profile with no significant adverse reaction observed. 25 – 27 …”

“…Other recent studies with intravitreal methotrexate for PVR have had positive anatomical and visual outcomes. 25 , 26 …”