Intravitreal Methotrexate for the Prevention and Treatment of Proliferative Vitreoretinopathy in Rhegmatogenous Retinal Detachment: A Systematic Review

This systematic review evaluates the role of methotrexate (MTX) as an adjunctive intravitreal agent for the prevention and treatment of proliferative vitreoretinopathy (PVR) in rhegmatogenous retinal detachment. Articles investigating the use of MTX in ≥5 patients with PVR or high risk of PVR were identified via searches of OVID MED-LINE, EMBASE, and Cochrane Library. Eight studies and 240 eyes were included. Patients received an average 2.2 MTX injections with doses ranging from 250 to 400 µg. After 10 months of follow-up in the three controlled trials, there was an 80% retinal re-attachment rate and 0.63 logMAR improvement in visual acuity for patients receiving MTX (n = 106), compared to an 83% reattachment rate and 0.30 logMAR improvement for controls (n = 91). Three mild complications related to MTX were reported. Further research is required given the low number of studies and quality of evidence, heterogenous case selection and treatment regimens, high risk of bias, and lack of randomization. [Ophthalmic Surg Lasers Imaging Retina 2022;53:561-568.].