Tianyu Liu, Margaret Runner, Tamer H Mahmoud, Antonio Capone, Kimberly A Drenser, Sandeep Randhawa, George A Williams, Lisa J Faia
{"title":"预防硅油去除后增殖性玻璃体视网膜病变的改良玻璃体内甲氨蝶呤方案","authors":"Tianyu Liu, Margaret Runner, Tamer H Mahmoud, Antonio Capone, Kimberly A Drenser, Sandeep Randhawa, George A Williams, Lisa J Faia","doi":"10.1016/j.oret.2024.10.006","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To utilize a modified intravitreal (IVT) methotrexate (MTX) protocol for the prevention of proliferative vitreoretinopathy (PVR) after silicone oil (SO) removal (SOR).</p><p><strong>Design: </strong>Single-center nonrandomized retrospective comparative case series.</p><p><strong>Subjects: </strong>Eyes with grade C PVR who underwent retinal detachment repair and SO placement between 2019-2022 with at least 6 months of follow-up after SOR. A control group of age- and sex-matched eyes was included.</p><p><strong>Methods: </strong>Eyes were treated with one of two MTX protocols. Eyes in Group 1 received 6 IVT MTX injections following SO placement, and another 6 IVT MTX injections following SOR. Eyes in Group 2 received 6 IVT MTX following SO placement only. Each series of 6 IVT MTX injections (400 μg/0.1 mL) consisted of 3 injections every 2 weeks followed by 3 injections every 4 weeks.</p><p><strong>Main outcome measures: </strong>The primary outcome was the retinal attachment rate at 6 months post-SOR without re-detachment or re-operation. Secondary outcomes included change in visual acuity (VA) and rates of complications after SOR.</p><p><strong>Results: </strong>Fifty-two eyes of 52 patients (13 Group 1, 13 Group 2, 26 control) (mean age 59.8 years, 80.8% male) were included with a mean follow-up of 31.0 months. In aggregate, Group 1 and Group 2 eyes received a median (IQR) of 6 (5.25, 7) IVT MTX injections pre-SOR; eyes in Group 1 received a median (IQR) of 5 (3, 6) IVT MTX injections post-SOR. Twelve (92.3%) Group 1 eyes, 11 (84.6%) Group 2 eyes, and 21 (80.8%) control eyes had primary retinal attachment at 6 months post-SOR (P > 0.05). VA outcomes did not significantly differ between groups (P > 0.05). Rates of epiretinal membrane (ERM) and cystoid macular edema (CME) were significantly lower in Group 1 eyes (7.7% and 15.4%) compared to Group 2 (53.8% and 92.3%) and control (44.3% and 65.4%) eyes, respectively (P < 0.05).</p><p><strong>Conclusions: </strong>The use of IVT MTX injections in eyes with PVR undergoing RD repair was associated with a high rate of primary retinal attachment after SOR. Eyes that received IVT MTX injections after SOR had significantly lower rates of ERM and CME than eyes that did not.</p>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":null,"pages":null},"PeriodicalIF":4.4000,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A Modified Intravitreal Methotrexate Protocol for the Prevention of Proliferative Vitreoretinopathy After Silicone Oil Removal.\",\"authors\":\"Tianyu Liu, Margaret Runner, Tamer H Mahmoud, Antonio Capone, Kimberly A Drenser, Sandeep Randhawa, George A Williams, Lisa J Faia\",\"doi\":\"10.1016/j.oret.2024.10.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To utilize a modified intravitreal (IVT) methotrexate (MTX) protocol for the prevention of proliferative vitreoretinopathy (PVR) after silicone oil (SO) removal (SOR).</p><p><strong>Design: </strong>Single-center nonrandomized retrospective comparative case series.</p><p><strong>Subjects: </strong>Eyes with grade C PVR who underwent retinal detachment repair and SO placement between 2019-2022 with at least 6 months of follow-up after SOR. A control group of age- and sex-matched eyes was included.</p><p><strong>Methods: </strong>Eyes were treated with one of two MTX protocols. Eyes in Group 1 received 6 IVT MTX injections following SO placement, and another 6 IVT MTX injections following SOR. Eyes in Group 2 received 6 IVT MTX following SO placement only. Each series of 6 IVT MTX injections (400 μg/0.1 mL) consisted of 3 injections every 2 weeks followed by 3 injections every 4 weeks.</p><p><strong>Main outcome measures: </strong>The primary outcome was the retinal attachment rate at 6 months post-SOR without re-detachment or re-operation. Secondary outcomes included change in visual acuity (VA) and rates of complications after SOR.</p><p><strong>Results: </strong>Fifty-two eyes of 52 patients (13 Group 1, 13 Group 2, 26 control) (mean age 59.8 years, 80.8% male) were included with a mean follow-up of 31.0 months. In aggregate, Group 1 and Group 2 eyes received a median (IQR) of 6 (5.25, 7) IVT MTX injections pre-SOR; eyes in Group 1 received a median (IQR) of 5 (3, 6) IVT MTX injections post-SOR. Twelve (92.3%) Group 1 eyes, 11 (84.6%) Group 2 eyes, and 21 (80.8%) control eyes had primary retinal attachment at 6 months post-SOR (P > 0.05). VA outcomes did not significantly differ between groups (P > 0.05). Rates of epiretinal membrane (ERM) and cystoid macular edema (CME) were significantly lower in Group 1 eyes (7.7% and 15.4%) compared to Group 2 (53.8% and 92.3%) and control (44.3% and 65.4%) eyes, respectively (P < 0.05).</p><p><strong>Conclusions: </strong>The use of IVT MTX injections in eyes with PVR undergoing RD repair was associated with a high rate of primary retinal attachment after SOR. Eyes that received IVT MTX injections after SOR had significantly lower rates of ERM and CME than eyes that did not.</p>\",\"PeriodicalId\":19501,\"journal\":{\"name\":\"Ophthalmology. 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A Modified Intravitreal Methotrexate Protocol for the Prevention of Proliferative Vitreoretinopathy After Silicone Oil Removal.
Objective: To utilize a modified intravitreal (IVT) methotrexate (MTX) protocol for the prevention of proliferative vitreoretinopathy (PVR) after silicone oil (SO) removal (SOR).
Design: Single-center nonrandomized retrospective comparative case series.
Subjects: Eyes with grade C PVR who underwent retinal detachment repair and SO placement between 2019-2022 with at least 6 months of follow-up after SOR. A control group of age- and sex-matched eyes was included.
Methods: Eyes were treated with one of two MTX protocols. Eyes in Group 1 received 6 IVT MTX injections following SO placement, and another 6 IVT MTX injections following SOR. Eyes in Group 2 received 6 IVT MTX following SO placement only. Each series of 6 IVT MTX injections (400 μg/0.1 mL) consisted of 3 injections every 2 weeks followed by 3 injections every 4 weeks.
Main outcome measures: The primary outcome was the retinal attachment rate at 6 months post-SOR without re-detachment or re-operation. Secondary outcomes included change in visual acuity (VA) and rates of complications after SOR.
Results: Fifty-two eyes of 52 patients (13 Group 1, 13 Group 2, 26 control) (mean age 59.8 years, 80.8% male) were included with a mean follow-up of 31.0 months. In aggregate, Group 1 and Group 2 eyes received a median (IQR) of 6 (5.25, 7) IVT MTX injections pre-SOR; eyes in Group 1 received a median (IQR) of 5 (3, 6) IVT MTX injections post-SOR. Twelve (92.3%) Group 1 eyes, 11 (84.6%) Group 2 eyes, and 21 (80.8%) control eyes had primary retinal attachment at 6 months post-SOR (P > 0.05). VA outcomes did not significantly differ between groups (P > 0.05). Rates of epiretinal membrane (ERM) and cystoid macular edema (CME) were significantly lower in Group 1 eyes (7.7% and 15.4%) compared to Group 2 (53.8% and 92.3%) and control (44.3% and 65.4%) eyes, respectively (P < 0.05).
Conclusions: The use of IVT MTX injections in eyes with PVR undergoing RD repair was associated with a high rate of primary retinal attachment after SOR. Eyes that received IVT MTX injections after SOR had significantly lower rates of ERM and CME than eyes that did not.
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