Association between Systemic Methotrexate Therapy and Proliferative Vitreoretinopathy.

Area of Science:

• Ophthalmology
• Retinal Surgery
• Pharmacology

Background:

• Proliferative vitreoretinopathy (PVR) is a primary cause of retinal detachment (RD) repair failure.
• Identifying factors to reduce PVR incidence is crucial for improving surgical outcomes.

Purpose of the Study:

• To investigate the association between systemic methotrexate (MTX) therapy and the incidence of PVR following RD repair.
• To explore the effects of other antimetabolite agents, such as azathioprine and mycophenolate mofetil, on PVR rates.

Main Methods:

• A multicenter retrospective cohort study was conducted using the Sight Outcomes Research Collaborative (SOURCE) repository.
• Patients aged 18 years or older who underwent primary RD repair between 2004 and 2024 were included.
• Systemic MTX use was assessed as the exposure, and new-onset PVR within 6 months of surgery was the primary outcome, analyzed using log binomial regression with inverse probability weighting.

Main Results:

• Of 2674 eligible patients, 1.8% were on systemic MTX. The 6-month PVR incidence was 4.2% for MTX users versus 9.2% for non-users (adjusted RR, 0.58).
• Systemic azathioprine also showed a significant reduction in PVR incidence (adjusted RR, 0.28).
• Mycophenolate mofetil did not demonstrate a significant association with reduced PVR incidence (adjusted RR, 0.93).

Conclusions:

• Patients receiving systemic methotrexate or azathioprine had a significantly lower likelihood of developing PVR within 6 months post-RD repair.
• These findings highlight a potential protective role for MTX and azathioprine in preventing PVR after retinal detachment surgery.