Intravitreal methotrexate as an adjuvant in vitrectomy in cases of retinal detachment with proliferative vitreoretinopathy.

PURPOSE: To compare the rate of re-detachment in patients with rhegmatogenous retinal detachment and Grade-C PVR following vitreoretinal surgery, with and without serial intravitreal injections of methotrexate. METHODS: It was a randomized control trial. Patients aged more than 18 years undergoing pars plana vitrectomy for rhegmatogenous retinal detachment with PVR grade C or more were included in the study. Patients treated with intravitreal injection of methotrexate were grouped as cases and those not injected served as controls. The cases received 3 intravitreal injections of methotrexate at monthly intervals. Patients were evaluated on Day 1, 1st month, 2nd month, 3rd month and 6th month in terms of BCVA, rate of re-attachment and grade of PVR. RESULTS: The case group had 23 patients and the control group had 20 patients. 2 patients in the case group were lost to follow-up after the first follow-up, so they were excluded. So 21 patients in case group and 20 patients in control group were followed up. Six months after surgery, 15 'cases' had completely attached retina whereas 6 patients had partial detachment with macula on. There was no patient amongst the cases with macula-off retinal re-detachment. Out of 20 patients in the control group, 9 had a complete retinal attachment, 4 had partial detachment with macula-on and 7 had partial detachment with macula-off. There was statistically significant difference in macula off retinal detachment rates (p-value- 0.003). CONCLUSION: Serial intravitreal methotrexate injections reduce the incidence of re-detachment in patients undergoing PPV for RRD with PVR-C. Further investigation into this promising therapeutic approach is warranted. KEY MESSAGES: What is known Methotrexate is an anti-inflammatory agent which is safe for intravitreal use There are case series retrospective and prospective studies suggesting potential benefit of intravitreal methotrexate in preventing re-detachment due to PVR What is new First randomized control trial studying the efficacy of intravitreal methotrexate in preventing re-detachment due to PVR Our study showed statistically significant difference in macula off retinal detachment between the 2 groups at 6 months of follow up.

Comparative Study of Microbiological Profile and Management Outcomes of Acute Endophthalmitis after Microincision Vitrectomy Surgery versus Intravitreal Injections.

Purpose: The aim of this study was to evaluate and compare incidence and outcomes of management of acute endophthalmitis after microincision vitrectomy surgery (MIVS) and intravitreal injections (IVIs).Methods: Medical records were retrospectively reviewed from January 2012 to December 2017, and the incidence, clinical and microbiological profiles of acute endophthalmitis were documented.Results: Of 26,332 MIVS and 24,143 IVI performed, incidence of acute endophthalmitis in MIVS group was 0.027% (1 in 3761 cases) against 0.054% (1 in 1857 cases) in IVI. Gram-positive organisms were causative in post IVI group as against gram-negative organisms in MIVS group.Conclusion: Incidence of endophthalmitis after IVI is almost twice that after MIVS. A trend toward poorer outcomes in MIVS eyes was observed. Both MIVS and IVI being pars plana procedures warrant similar kind of aseptic precautions.

Real-world outcomes of intravitreal anti-vascular endothelial growth factor monotherapy in proliferative type 2 macular telangiectasia.

BACKGROUND: To study the effect of anti-VEGFs in proliferative MacTel 2 METHODS: Sixty-four eyes of 51 patients of MacTel 2 with subretinal neovascular membrane (SRNVM) undergoing intravitreal anti-VEGF monotherapy at our institution between January 2015 and December 2018 were evaluated for visual acuity, central macular thickness (CMT) and total macular volume (TMV) using optical coherence tomography (OCT). Repeat investigations were performed at the final follow-up. RESULTS: Location of SRNVM was foveal (F) in 65.6% eyes and extrafoveal (EF) in 34.4% eyes. Both CMT and TMV were lower significantly at baseline in EF-SRNVM. Fifty-six eyes received intravitreal bevacizumab and 8 eyes received ranibizumab. Average 2.14 ± 1.21 injections (range, 1-6) were administered. After a mean follow-up duration of 16.01 ± 12.96 months, the final visual acuity (VA) improved in 35.9% eyes, reduced in 28.1% and remained unchanged in 35.9% eyes. Significant improvement of VA was seen in F-SRNVM; however, overall, there was no significant improvement in visual acuity. Significant reduction in CMT was seen in F-SRNVM from 391.73 ± 152.45 µm to 293.33 ± 114.77 µm (p < 0.05) while EF-SRNVM did not show significant reduction. Total macular volume overall changed significantly from 8.79 ± 1.69 to 8.05 ± 1.27 (p < 0.05) and individually in F- and EF-SRNVM (p < 0.05). Intravitreal bevacizumab and ranibizumab monotherapy both had similar efficacy. CONCLUSIONS: Anti-VEGF agents can be successfully used to treat proliferative MacTels. Macular volume measurement on OCT may be a useful parameter for evaluating EF-SRNVM and as a prognostic marker of management outcomes.