ASRS 2025: Postoperative methotrexate injections to decrease reoperation rate

Alan J. Franklin, MD, PhD, FASRS, presented, "Postoperative methotrexate injections decrease reoperation rate and improve vision following vitrectomy for PDR and complex retinal detachments," at the 2025 Annual Scientific meeting of the American Society of Retina Specialists. This meeting was held in Long Beach, California from July 30 through August 2, 2025.

In a conversation with Ophthalmology Times, Franklin spoke to the use of methotrexate in treating retinal detachments, particularly in complex patient populations like diabetics. The findings from a retrospective study involving 251 patients (160 non-treated and 91 methotrexate-treated eyes), demonstrated a significant 57% reduction in reoperation rates. The patient cohort was diverse, comprising approximately two-thirds diabetics, one-third complex retinal detachments (including giant tears and PVR), and a small number of trauma cases. Initially, the treatment protocol involved weekly methotrexate injections for 13 weeks at 400 micrograms. However, the approach was refined based on a colleague's limited injection protocol. The current methodology involves a more flexible injection schedule:

• For mild proliferation: 3 injections (weeks 2, 4, and 6 post-op)
• Standard protocol: 5 injections (weeks 1, 2, 4, 7, and 11)

The dose was reduced to 200 micrograms, with patients typically receiving an average of 4 injections. The key therapeutic mechanism is methotrexate's ability to inhibit scar tissue formation, which is particularly beneficial in patients with fibrotic or fibrovascular proliferation. The speaker highlights the similarities in mechanisms between proliferative diabetic retinopathy (PDR) and proliferative vitreoretinopathy (PVR), suggesting the potential for broader application of this treatment approach. Looking forward, the researcher proposes two significant next steps:

1. Conducting a prospective study specifically focused on diabetic patients
2. Awaiting findings from the FIXER study, a prospective investigation into primary retinal detachments, to be presented by Dr. Chris Riemann

The discussion underscores the importance of innovative treatment strategies in managing complex retinal conditions, particularly in challenging patient populations with high surgical risk and potential for complications.