Clinical Scorecard: Intravitreal Methotrexate Formulation Lowers Postoperative Complications

At a Glance

Key Highlights

• ADX-2191 linked to reduced rates of hypotony and cystoid macular edema in PVR surgery.
• 24% reoperation rate in ADX-2191 group vs. 39% in historical controls (P=.024).
• Mild to moderate punctate keratitis occurred in 16% of patients receiving ADX-2191.
• Study suggests fewer retinal detachments with ADX-2191, although not statistically significant.
• Routine surgical care plus ADX-2191 showed numerically superior outcomes.

Guideline-Based Recommendations

Diagnosis

• Assess for recurrent retinal detachments due to PVR with at least 3 clock hours of star folds or epiretinal membranes.

Management

• Consider adjunctive intravitreal methotrexate (ADX-2191) during PVR repair to reduce postoperative complications.

Monitoring & Follow-up

• Monitor for adverse events such as punctate keratitis and assess reoperation rates.

Risks

• Potential for mild to moderate punctate keratitis and other postoperative complications.

Patient & Prescribing Data

Patients with recurrent retinal detachments due to PVR.

Patients received 13 injections over 4 months, including intraoperative and weekly doses.

Clinical Best Practices

• Utilize ADX-2191 for its optimized formulation and reduced volume for intravitreal injection.
• Evaluate historical controls for comparative outcomes in PVR surgery.

References

• Liu T et al. (2025)
• Ullah A et al. (2023)