Intravitreal methotrexate for the treatment of proliferative vitreoretinopathy

Abstract

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.

Figure 1

Fundus photograph of the left eye of patient 2 taken methotrexate 14 months after surgery. Note the well-healed laser scar along the 360° retinectomy. There are no fibrotic or pigmented epiretinal membranes along edge of the retinectomy. There is a macular pucker and a few intraretinal haemorrhages.

Figure 2

Fundus photograph of the right eye of patient 3 taken methotrexate 6 months after surgery. This patient had a history of vitelliform dystrophy associated with foveal atrophy and was status-post macular hole repair. Note the well-healed laser scar along the retinectomy without evidence of proliferative vitreoretinopathy. There is focal fibroglial membrane along with inferior arcade without any significant traction.

Figure 3

Fundus photograph of the right eye of patient 4 taken methotrexate 7 months after surgery. There is a well-healed laser scar along with the inferior retinectomy and without any fibrotic or pigmented epiretinal membranes.

Figure 4

Fundus photograph of a patient with proliferative vitreoretinopathy (not in this study) that is shown for illustrative purposes. This patient required multiple retinal surgeries and permanent silicone oil tamponade (did not receive intravitreal methotrexate or extended perfluorocarbon liquid tamponade). Note the thick pigmented and white fibrotic membranes (both subretinal and epiretinal) along the retinectomy edge and also extending through the macula. There is a tractional retinal detachment.