The Role of Systemic Methotrexate on Preventing Proliferative Vitreoretinopathy Following Retinal Detachment Repair

This study aimed to evaluate the association between systemic methotrexate (MTX) use and the incidence of proliferative vitreoretinopathy (PVR) following retinal detachment (RD) repair.

A retrospective cohort study was conducted using the TriNetX Health Research Network. Patients undergoing RD repair were identified by CPT codes and stratified into MTX users (systemic exposure within one year prior to or on the day of RD repair) versus nonusers. Cases of proliferative diabetic retinopathy were excluded. The primary endpoint was development of PVR-related complications within 3, 6, and 12 months postoperatively. Propensity score matching (PSM) was performed to balance baseline demographics and clinical covariates.

After 1:1 PSM, 496 patients were identified in both cohorts (mean age: 56.5 (19.0) years). MTX use was associated with significantly higher odds of tractional RD at 3 months (22.38% vs 8.06%; odds ratio [OR] 3.28, 95% CI: 2.23-4.83, P < .0001), 6 months (24.95% vs 8.11%; OR 3.76, 95% CI: 2.57-5.52, P < .0001), and 12 months (20.29% vs 10.63%; OR 2.14, 95% CI: 1.44-3.17, P < .0001). Postoperative ERM development was more frequent in MTX cohort at 3 months (11.49% vs 6.65%, OR 1.82, 95% CI: 1.16-2.85, P = .0080). No significant differences were observed in complex RD repair, repeat PPV, and PPV with ERM removal.

Systemic MTX use within one year of RD repair was not associated with a reduced risk of PVR. MTX exposure correlated with increased odds of tractional RD and higher rates of ERM development rate. These findings suggest systemic MTX may not offer protective benefit against PVR.