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. 2025 Nov 1;45(11):2086-2095.
doi: 10.1097/IAE.0000000000004602.

REAL-WORLD EFFICACY OF INTRAVITREAL METHOTREXATE FOR MANAGING PROLIFERATIVE VITREORETINOPATHY IN RECURRENT RHEGMATOGENOUS RETINAL DETACHMENT

Justin S Yun  1 , Blake H Fortes  2 , Marcus H Yamamoto  3 , Adrian C Au  2 , Pradeep S Prasad  2 , Colin A McCannel  2 , Irena Tsui  2 , Tara A McCannel  2 , Hamid Hosseini  2 , David Lozano Giral  2 , Aya Barzelay-Wollman  2 , Moritz S Pettenkofer  2 , Kirk K Hou  2
Affiliations

REAL-WORLD EFFICACY OF INTRAVITREAL METHOTREXATE FOR MANAGING PROLIFERATIVE VITREORETINOPATHY IN RECURRENT RHEGMATOGENOUS RETINAL DETACHMENT

Justin S Yun et al. Retina. .

Abstract

Purpose: To evaluate the efficacy of serial intravitreal methotrexate injections as an adjunct to surgical repair in the management of recurrent rhegmatogenous retinal detachment because of proliferative vitreoretinopathy.

Methods: A retrospective cohort study was conducted involving 41 eyes with a history of failed rhegmatogenous retinal detachment repair presenting with recurrent rhegmatogenous retinal detachment and grade C1 to D proliferative vitreoretinopathy, treated with pars plana vitrectomy and serial methotrexate injections were included, separated into group 1 (with modified Gain Understanding Against Retinal Detachment protocol, n = 27) and group 2 (without modified Gain Understanding Against Retinal Detachment protocol, n = 14). The primary outcome was retinal reattachment rate, and secondary outcomes were changes in visual acuity and postoperative complications.

Results: Retinal reattachment was achieved without additional surgery in 21 (77.8%) eyes in group 1 and 10 (71.4%) in group 2 at final follow-up, with no statistical significance. Improvement in logarithm of the minimal angle of resolution was 0.50 in group 1 and 0.44 in group 2, with a median follow-up of 12.1 months from surgery and no differences in postoperative complications.

Conclusion: There were no differences in retinal reattachment or visual acuity outcomes between both methotrexate regimens. The overall reattachment rate exceeded previously reported rates for recurrent rhegmatogenous retinal detachment with proliferative vitreoretinopathy. Further research is needed to optimize the injection protocol for better clinical outcomes.

Keywords: GUARD protocol; intravitreal methotrexate; proliferative vitreoretinopathy; rhegmatogenous retinal detachment.

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