Regression of a Subretinal Proliferation Band with Intravitreal Methotrexate in Recurrent Retinal Detachment: A Case...

Subretinal bands, a form of proliferative vitreoretinopathy, can cause surgical failure following rhegmatogenous retinal detachment (RRD). Intravitreal methotrexate injection showed growing interest for preventing proliferative vitreoretinopathy. This case report illustrates the regression of an existing subretinal band with the use of Intravitreal methotrexate in a case of recurrent retinal detachment.

Report of a case.

A 24-year-old male presented with RRD and underwent primary scleral buckle and cryotherapy. On postoperative week 10, a stretch hole formed at the distal end of a temporal subretinal band, resulting in re-detachment. The patient was managed surgically with pars plana vitrectomy, subretinal band removal, endolaser, and silicone oil placement. A smaller subretinal band was also noted closer to the fovea. Starting on postoperative day 5, five intravitreal methotrexate (400 µg/0.05 mL) injections were administered over six weeks to prevent proliferative vitreoretinopathy. Serial OCT imaging showed gradual regression of the small subretinal band. By postoperative week 12, the subretinal band had significantly regressed, with vision improving from 20/125 to 20/40.

This case highlights subretinal band regression following intravitreal methotrexate injections in a patient with recurrent RRD. Methotrexate's anti-inflammatory and anti-proliferative properties may offer a beneficial effect in mitigating subretinal proliferative vitreoretinopathy, which can be surgically challenging.