Intravitreal Methotrexate and Retinectomy for Proliferative Vitreoretinopathy

This video shows a surgical technique for treating patients with recurrent retinal detachment due to severe proliferative vitreoretinopathy (PVR). The technique involves a 180° inferior relaxing retinectomy, extended PFCL tamponade followed by a series of 5 intravitreal methotrexate injections over a period of 10 weeks.

This 53-year-old patient had a detached retina from PVR after a previous scleral buckle and vitrectomy. She had prominent macular pucker that was peeled at the time of the surgery. Her retina was successfully reattached and the tamponade was removed 5 weeks later. She underwent a series of 5 methotrexate injections administered every 2 weeks over a 10-week period. At 7 months, her retina remains attached and her vision was 20/63. The laser scar is well-healed along the cut retinectomy edge. There is no fibrosis or pigmentation along the laser scar. 

Drs. Benner and Butler have performed this treatment protocol in 5 other patients with recurrent retinal detachment due to severe PVR. Each has done well over the mean follow-up of 17.4 months; no patient has experienced redetachment. Their findings were published in April 2019 issue of BMJ Open Ophthalmology.

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