Intraocular Methotrexate for the Treatment and Prevention of Proliferative Vitreoretinopathy: A Review.

Purpose: To review the current literature on the use of intravitreal methotrexate (IVT MTX) for the treatment and prevention of proliferative vitreoretinopathy (PVR). Methods: All reports of IVT MTX to treat and prevent PVR published in PubMed, Google Scholar, and EBSCOhost were reviewed. The relevant current studies are included in this report. Results: The literature search yielded 32 articles describing the use of MTX in PVR. These included preclinical studies, 1 case report, and several case series. Early studies found that IVT MTX is a promising medication for the treatment and prevention of PVR. MTX works as a potent anti-inflammatory agent through a new mechanism of action different from that of other medications for use in PVR. Few side effects have been reported and were mostly limited to mild reversible corneal keratopathy. There are 2 current ongoing randomized controlled clinical trials to further evaluate the efficacy of MTX for PVR. Conclusions: MTX is a safe and potentially efficacious medication for the treatment and prevention of PVR. Additional clinical trials are needed to further establish this effect.

Intravitreal Rituximab-Associated Retinal Occlusive Vasculitis.

Purpose: To describe a 90-year-old patient who was referred to a private retina specialist with gradually worsening vision and floaters in the left eye. Methods: A retrospective case report is presented. Results: The patient was treated with intravitreal rituximab injections for intraocular lymphoma with resulting vision loss to the level of hand motions from severe granulomatous uveitis and retinal occlusive vasculitis. Conclusions: Retinal occlusive vasculopathy secondary to rituximab intravitreal injections is a rare clinical entity with only a single previous case reported in the literature. However, there are reports of systemic vasculitis after systemic administration of rituximab. Clinicians should be aware of the possibility of ocular hypertension, granulomatous anterior uveitis, and/or retinal occlusive vasculitis after intravitreal rituximab use. Consideration should be given to the inflammatory risk of rituximab intravitreal injections to reduce the potential for treatment-induced vision loss.

Rickettsia rickettsii infection as an unusual cause of pediatric retinitis: A case report.

Purpose: To report a case of infectious pediatric retinitis attributed to Rocky Mountain spotted fever which is rarely reported in the United States. Observations: A previously healthy 14-year-old male return traveler from Mexico was admitted to the pediatric ICU with septic shock and a diffuse rash. He subsequently complained of blurry vision and was found to have evidence of retinitis on exam. Infectious workup revealed high titers of rickettsial IgM and IgG antibodies. He was treated successfully with 14 days doxycycline and followed up in clinic with improvement in his visual complaints and retinitis. Conclusions and importance: Rickettsioses are worldwide endemic zoonotic infections caused by Gram negative obligate intracellular bacteria and spread to humans by infected ticks. Rickettsial infections, including Rocky Mountain spotted fever caused by Rickettsia rickettsii, are a cause of infectious retinitis, and atypical and zoonotic infections should remain on the differential diagnosis for patients presenting with rash, systemic illness, and visual complaints, even if the patient's travel or exposure history do not immediately suggest a likely rickettsial infection. In general, the ocular manifestations of rickettsial infection improve with systemic doxycycline treatment of the underlying infection.

X-Linked Retinoschisis and a Coats-Like Response in the Setting of Retinopathy of Prematurity.

PURPOSE: This case report describes a unique case of a young patient with retinopathy of prematurity (ROP), a unilateral Coats-like response, and X-linked retinoschisis (XLRS). METHODS: A 9-year-old boy with a history of regressed ROP presented with a unilateral Coats-like response, subretinal exudation, and XLRS. Examination and imaging findings demonstrated a highly unique combination of bilateral retinoschisis and a dramatic unilateral Coats-like response with a large schisis cavity. RESULTS: Treatment with laser photocoagulation and anti-VEGF therapy led to resolution of the subretinal exudative changes. CONCLUSIONS: This is the first published description to our knowledge of a patient with a Coats-like response, XLRS, and a history of regressed ROP with resolution after treatment.