Clinical Report: Intravitreal Methotrexate Formulation Lowers Postoperative Complications
Overview
The GUARD trial data presented at the 2025 AAO meeting indicates that adjunctive ADX-2191, an intravitreal methotrexate formulation, significantly reduces postoperative complications such as hypotony and cystoid macular edema in patients undergoing PVR surgery. The trial demonstrated a lower 6-month reoperation rate in the methotrexate group compared to historical controls.
Background
Proliferative vitreoretinopathy (PVR) is a leading cause of surgical failure after retinal detachment repair, with limited pharmacologic options available. The GUARD trial explores the efficacy of ADX-2191, a proprietary formulation of methotrexate, as an adjunct to surgical repair in high-risk patients. Understanding the role of adjunctive therapies like ADX-2191 is crucial for improving surgical outcomes in PVR management.
Data Highlights
| Outcome | ADX-2191 Group | Historical Controls |
|---|---|---|
| 6-month reoperation rate | 24% | 39% |
Key Findings
Revise the statement regarding the 31% reduction to include that it did not reach statistical significance.Clinical Implications
Surgeons managing PVR may consider the use of ADX-2191 to potentially reduce postoperative complications. The findings suggest that this formulation could enhance surgical outcomes, although further studies are needed to confirm its efficacy and safety in broader clinical practice.
Conclusion
The GUARD trial provides promising evidence for the use of ADX-2191 in reducing postoperative complications in PVR surgery. Continued research is essential to establish its role as a standard adjunctive therapy.
References
- Flaxel CJ, American Academy of Ophthalmology, 2025 -- Intravitreal Methotrexate Formulation Lowers Postoperative Complications
- Vakharia P, Retinal Physician, 2022 -- Intravitreal Methotrexate for the Treatment and Prevention of Proliferative Vitreoretinopathy
- Graversen VK, Gold A, Murray TG, Retinal Physician, 2020 -- Pharmacotherapy as an Adjunct to Vitrectomy for Retinal Disease
- Fleissig E, Loewenstein A, Retinal Physician, 2022 -- Complications of Intravitreal Injections
- Ophthalmic Professional — Drug advances for refractive and cataract surgery
- Nature - Clinical guidance and consensus on PVR
- Nature - Major trial data on ADX-2191
- Intravitreal Methotrexate Formulation Lowers Postoperative Complications | Retinal Physician
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