Intravitreal methotrexate for the treatment of proliferative vitreoretinopathy

BMJ Open Ophthalmol. 2019 Apr 1;4(1):e000293. doi: 10.1136/bmjophth-2019-000293. eCollection 2019.


Background/aims: Preventing and treating proliferative vitreoretinopathy (PVR) remain a serious challenge for vitreoretinal surgeons. PVR is a devastating complication of retinal detachment that results in recurrent detachment and limits visual recovery. At present, there is no effective treatment for PVR.

Materials and methods: A retrospective review was performed on a cohort of five consecutive eyes with severe PVR and recurrent retinal detachment that were treated with relaxing retinectomy, extended perfluorocarbon liquid tamponade (4-5 weeks) and a series of intravitreal methotrexate (MTX) injections (100-200 µg/0.05 mL for 10 weeks).

Results: All five patients remained reattached (100%) with 11-27 months of follow-up (mean = 17.4). 4 eyes recovered ambulatory vision (>20/200) with normal intraocular pressure and non-fibrotic laser scars along with the relaxing retinectomy. The initial patient remained reattached, but only had hand motions vision. The only adverse effect noted was mild superficial punctate keratopathy in one patient.

Conclusion: This small, retrospective study suggests that a series of MTX injections may be beneficial for treating complex retinal detachment caused by PVR. Further study is indicated.

Keywords: inflammation; pharmacology; retina; treatment medical; treatment surgery.