Abstract
Introduction: Proliferative vitreoretinopathy (PVR) is a difficult-to-treat complication of retinal detachment (RD) repair. Intravitreal methotrexate (MTX) has emerged as a promising adjuvant therapy. In the GUARD trial, patients with PVR-associated detachments who received 13 injections of investigational vitreous-compatible MTX over 16 weeks had reduced risk of re-detachment compared to historical controls. We evaluated the safety and clinical outcomes of using off-label intravitreal compounded MTX in patients with PVR-associated detachments in a real-world setting.
Methods: A chart review was conducted of patients at a tertiary academic center who received at least 8 intravitreal injections of compounded MTX (0.1mL, 0.4mg) as off-label adjuvant therapy for PVR-associated RD repair. Primary outcome was re-attachment rate without additional surgical intervention at 6 months and through duration of follow up. Secondary outcomes included change in best corrected visual acuity (BCVA) and rates of hypotony, epiretinal membrane (ERM) formation, cystoid macular edema (CME), and corneal epitheliopathy.
Results: Nineteen eyes were included (mean 11.6 injections per eye). All remained attached at 6 months under silicone oil, and 17 eyes (89.5%) remained attached over a mean follow up interval of 35 months. Of 10 eyes (52.6%) that underwent silicone oil removal, 8 (80%) remained attached. At last follow up, BCVA improved in 13 eyes (68.4%), and there were 2 eyes (10.5%) with hypotony, 10 eyes (52.6%) with ERM, 8 eyes (42.1%) with CME, and 4 eyes (21.1%) with corneal epitheliopathy.
Conclusions: Intravitreal MTX can be a safe, adjuvant therapy following repair of recurrent PVR detachment, and is associated with high re-attachment rates even when used in the real-world as off-label compounded therapy with a variable number of injections. Further study of intravitreal MTX in the treatment and prevention of PVR is indicated.