Sadaka Ama, Sisk Robert A, Osher James M, Toygar Okan, Duncan Melinda K, Riemann Christopher D
Department of Ophthalmology, University of Cincinnati College of Medicine.
Department of Ophthalmology, University of Cincinnati College of Medicine; Department of Opthalmology, Cincinnati Children's Hospital Medical Center; Cincinnati Eye Institute, Cincinnati, OH, USA.
Clin Ophthalmol. 2016 Sep 19;10:1811-1817. doi: 10.2147/OPTH.S111893. eCollection 2016.
The purpose of this study was to evaluate intravitreal methotrexate infusion (IMI) during pars plana vitrectomy (PPV) for retinal detachment in patients with high risk for the development of proliferative vitreoretinopathy (PVR).
Patients presenting with severe recurrent PVR with tractional retinal detachment and/or a history of severe ocular inflammation were treated with IMI. Clinical outcomes were determined from a retrospective medical chart review.
Twenty-nine eyes presenting with either tractional retinal detachment and recurrent PVR (n=22) or a history of severe inflammation associated with high PVR risk (n=7) received IMI during PPV. Best-corrected visual acuity at 6 months was ≥20/200 in 19 of 29 eyes (66%) and remained stable or improved compared with initial presentation in 24 of 29 eyes (83%). At the last follow-up examination, the retinas of 26 of 29 eyes (90%) remained attached after IMI while three eyes required another reattachment procedure. Three additional eyes (10%) developed recurrent limited PVR without recurrent RD and were observed. No complications attributable to IMI occurred during a mean follow-up of 27 months.
Eyes at high risk for PVR development due to a history of prior PVR or intraocular inflammation had a low incidence of PVR following IMI at the time of PPV for RD repair. No significant safety issues from IMI were observed in this series.
本研究旨在评估在玻璃体视网膜增殖性病变（PVR）发生风险较高的视网膜脱离患者行玻璃体切割术（PPV）时玻璃体内注射甲氨蝶呤（IMI）的效果。
对出现严重复发性PVR伴牵引性视网膜脱离和/或有严重眼部炎症病史的患者进行IMI治疗。通过回顾性病历审查确定临床结果。
29只眼在PPV期间接受了IMI治疗，其中22只眼出现牵引性视网膜脱离和复发性PVR，7只眼有与高PVR风险相关的严重炎症病史。29只眼中有19只（66%）在6个月时最佳矫正视力≥20/200，29只眼中有24只（83%）与初始表现相比视力保持稳定或提高。在最后一次随访检查时，29只眼中有26只（90%）的视网膜在IMI后保持附着，而3只眼需要再次进行复位手术。另外3只眼（10%）出现复发性局限性PVR但无复发性视网膜脱离，予以观察。在平均27个月的随访期间未发生与IMI相关的并发症。
因既往有PVR或眼内炎症病史而发生PVR风险较高的眼，在PPV修复视网膜脱离时行IMI后PVR发生率较低。本系列研究未观察到IMI有明显的安全问题。
