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Abstract
The most common cause of failure in repair of rhegmatogenous retinal detachment is proliferative vitreoretinopathy (PVR); it is common in grade C disease where serial surgeries and poor prognosis of visual results are the norm. Recently, methotrexate (MTX) a biologically plausible case, which possesses both anti-inflammatory and antiproliferative properties, has been studied as an adjunct to vitreoretinal surgery. It was a systematic review performed using PRISMA 2020 that assessed the clinical efficiency of intravitreal and intra-silicone oil MTX as a preventive and curative agent against PVR. They consisted of nine studies, consisting of randomized clinical trial, interventional cohorts, comparative studies, real-world series, and case reports. In these reports, MTX continued to cut back postoperative growth, decrease PVR recurrence and improve anatomical security in chance-high or recurrent cases. Interestingly, the repetitive intra-silicone oil injections showed that there is a significant reduction in the limited recurrence of PVR without augmentation of ocular toxicity. Reproductive reared through modified postoperative regimens in and around the silicone oil removal also resulted in reproductive reduction. MTX was mainly very well-tolerated and infrequent incidences of corneal epitheliopathy of a transient nature and lack of serious adverse effects that restricted treatment compliance. Also, good results come at the cost of heterogeneity in dosing schedules, time of administration as well as patient selection, which impedes comparability and prevents standardized clinical recommendations. To determine the best therapeutic application of MTX in the treatment of PVR, larger randomized multicenter studies with single protocols and extended follow-ups are required.