Intra-silicone oil injection of methotrexate at the end of vitrectomy for advanced proliferative diabetic retinopathy

PurposeTo evaluate the role of methotrexate (MTX) injected into the silicone oil at the end of pars plana vitrectomy for advanced proliferative diabetic retinopathy (PDR).MethodsIn this prospective comparative interventional study, eyes with severe diabetic tractional macular detachment or combined tractional/rhegmatogenous retinal detachment were included. Standard 20 gauge pars plana vitrectomy, and retinal reattachment was performed. In the case group, 250 μg MTX was injected into the silicone oil at the end of surgery. The rate of retinal re-detachment associated with fibrovascular proliferation or proliferative vitreoretinopathy (PVR) was assessed.ResultsOverall, 38 eyes of 35 patients (19 cases and 19 controls) were studied. The two groups were matched for age, sex, preoperative visual acuity, and the type of surgery (vitrectomy alone vs combined phacoemulsification/vitrectomy). Retinal re-detachment with fibrovascular proliferation or PVR occurred in seven eyes (36.8) in the MTX group and eight eyes (42.1) in the control group (P=0.74). Mean change in visual acuity was 0.04±0.71 and 0.39±0.70 logMAR in the MTX and the control group, respectively (P=0.14). The rate of improvement or worsening of visual acuity was similar between the two groups (P=0.51 and P=0.12).ConclusionIntra-silicone injection of MTX at the end of vitrectomy for retinal detachment associated with severe PDR did not reduce the risk of postoperative retinal detachment due to the fibrous or fibrovascular proliferations. © 2015 Macmillan Publishers Limited

Intraocular lens power calculation in keratoconus; a review of literature

Purpose: To review the published literature regarding cataract surgery in keratoconus (KCN) patients with emphasis on challenges encountered during intraocular lens (IOL) power calculation and their solutions. Methods: A literature review was performed to investigate all the relevant articles on the advancements of IOL calculations in KCN patients. Results: Cataract surgery in keratoconic eyes can improve patients' refraction, and proper patient selection and IOL calculation methods are necessary to get the best results. The main problem in KCN patients is unreliable biometric measurements. It is more difficult to make conclusions in more advanced keratoconic corneas, as the steep keratometric values in these eyes will result in the selection of a low-power IOL. Presence of a low-power IOL will yield in extreme postoperative hyperopia, and IOL exchange might be mandatory. In cases in which keratoplasty may be needed in the future, contact lens fitting can help surgeons make a better decision preoperatively. Axial length (AL) measurements may have better repeatability and reproducibility than keratometry (K) readings in keratoconic eyes. SRK II formula may provide the most accurate IOL power in mild KCN. There is still not a comprehensive consensus of which formula is the best one in moderate and severe KCN, as the literature is limited in this subject. Conclusions: Various methods of IOL power calculation optimization and recommendations may hold the key to improve surgical outcomes in keratoconic eyes. There are multiple sources of biometric error in KCN patients, hence IOL calculation methods may not be as efficient as expected in these eyes. © 2019 Iranian Society of Ophthalmolog

Effect of intravitreal injection of methotrexate on human corneal endothelial cells

Purpose: To evaluate the toxic effect of intravitreal methotrexate on human corneal endothelium. Methods: In this prospective noncomparative interventional case series, intravitreal injection of 400 mg methotrexate was performed in eyes with persistent diabetic macular edema. Corneal endothelial cell analyses and central corneal thickness measurements were performed before and 1, 3, and 6 months after injections, using noncontact specular microscopy. Results: Twenty one eyes of 18 patients with a mean age of 60.5 ± 6.8 years were evaluated. No statistically significant difference was found in endothelial cell density, coefficient of variation, average cell area, hexagonality, and central corneal thickness measurements before and after injections (P = 0.70, 0.39, 0.43, 0.64, and 0.67, respectively). Conclusions: In this 6-month follow-up study, intravitreal injection of 400 mg methotrexate had no significant effect on corneal endothelial cell measurements performed by specular microscopy. © 2015 Wolters Kluwer Health, Inc. All rights reserved

Intra-silicone Oil Injection of Methotrexate in Retinal Reattachment Surgery for Proliferative Vitreoretinopathy

Purpose: To evaluate the role of intrasilicone oil injection of methotrexate (MTX) at the end of vitrectomy surgery for rhegmatogenous retinal detachment (RRD) associated with proliferative vitreoretinopathy (PVR). Methods: In this prospective comparative study, pars plana vitrectomy and retinal reattachment were performed for eyes with RRD with grade C PVR. In the MTX group, 250 µg MTX was injected into the silicone oil at the end of surgery. The rate of retinal redetachment associated with PVR was assessed. Results: In total, 44 eyes of 44 patients (22 in the MTX group and 22 controls) were included. Baseline characteristics were similar between the two groups. Retinal redetachment occurred in one eye (4.5) in the MTX group and five eyes (22.7) in the control group (p = 0.18). The change in visual acuity was similar between the two groups at final visit (p = 0.15). Conclusion: The rate of redetachment associated with PVR was lower after intrasilicone injection of MTX at the end of vitrectomy for RRD with severe PVR compared to control group; however, the difference was not statistically significant. © 2019, © 2019 Taylor & Francis Group, LLC