Efficacy and safety of methotrexate in the treatment of proliferative vitreoretinopathy: a systematic review.

Abstract

Proliferative Vitreoretinopathy (PVR) is a major complication of surgical repair for Rhegmatogenous Retinal Detachment (RRD). Methotrexate (MTX), a folate antimetabolite, has shown promise in targeting the pathological processes involved in PVR, such as cell proliferation inhibition, fibrosis and anti-inflammation. Systematic review examines the use of MTX in PVR by analysing different administration methods and outcomes. A review of relevant studies from PubMed, EMBASE, and Open Access databases was conducted, focusing on studies investigating the role of MTX in PVR. Study characteristics, patient demographics, dosages, administration frequency, and patient outcomes were extracted. Vitrectomy with various additional procedures such as laser photocoagulation, scleral buckling, gas tamponade and membranectomy were performed during primary and repeated surgery. Among the 180 eyes studied, those receiving MTX through intravitreal injection or intraoperative infusion showed promising outcomes, with retinal reattachment rates ranging from 74 to 92%. Eyes that received MTX infusion intraoperatively had an average retinal reattachment rate of 85%. Improvement in Best Corrected Visual Acuity was also observed in all eyes receiving MTX, with low rates of adverse events reported. Re-operation rates for repeated retinal detachment is significantly lower at 18% for eyes that received MTX treatment compared to those who did not receive MTX at initial surgery. Despite positive findings, further research is needed due to limitations such as small number of studies, low quality of evidence, and heterogeneity in treatment regimens. While MTX shows potential as an adjunctive treatment for PVR in RRD, more robust studies are necessary to confirm its efficacy.