Use of intravitreal methotrexate infusion in complicated retinal detachment for prevention of proliferative vitreoretinopathy in a pilot study

Objective: The objective of this pilot study was to evaluate the efficacy and safety of per-operative intravitreal methotrexate (MTX) infusion during vitrectomy in patients of retinal detachment (RD) with advanced grade proliferative vitreoretinopathy (PVR).Methods: In this prospective interventional case series, we included patients with Grade C PVR, recurrent RD, and open globe trauma. All patients underwent standard single surgeon operated 23-gauge pars plana vitrectomy (PPV) with 80mg of MTX in 1000mL of irrigation fluid. All patients were followed up after four months to assess the final status of retinal attachment and visual acuity. Ethical review board permission was sought for this off-label use of MTX and all patients signed an informed consent form before this intervention.Results: Thirty eyes of 30 patients with recurrent retinal detachment, open globe trauma, or grade C PVR at initial presentation were included in this study. After PPV, these patients were followed up after four months. A total of 24 (80%) patients maintained retinal attachment at four months. Mean preoperative best-corrected visual acuity (BCVA) was 1.35 logarithm of the minimum angle of resolution (logMAR) (range 0.5-3) and mean four months postoperative BCVA was 1.01 logMAR (range 0.3-3) (Student’s t-test; P-value Conclusion: Intravitreal MTX infusion during PPV for complicated RD as an adjunctive therapy showed encouraging results and was found to be safe in its use. We need more rigorous and controlled studies to confirm the possible advantages of MTX and its role in the prevention of PVR.