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Intravitreal methotrexate as a prophylactic strategy for proliferative vitreoretinopathy in high-risk retinal
Adrian Konstantin Luyken1, Claudia Brockmann2, Valentin Junge2
1Department of Ophthalmology, Rostock University Medical Center, Doberaner Straße. 140, 18057, Hanseatic and University City of Rostock, Germany. adriankonstantin.luyken@med.uni-rostock.de.
Background:
Proliferative vitreoretinopathy (PVR) remains the major cause of surgical failure in rhegmatogenous retinal detachment (RRD). This study evaluates the anatomical and functional outcomes, as well as the safety, of a standardized intraoperative intravitreal methotrexate infusion protocol during pars plana vitrectomy (PPV) in eyes with early stage PVR (grade B) or with advanced PVR (grade C).
Methods:
A retrospective case series was conducted on 60 consecutive eyes of 59 patients with RRD and PVR grade B (n = 29) or grade C (n = 31) undergoing PPV with adjunct intraoperative methotrexate between November 2024 and February 2026 at a German tertiary center. Methotrexate 40 mg was administered via a 500 mL balanced salt solution infusion. Functional and structural testing included best-corrected visual acuity (BCVA), intraocular pressure, multifocal electroretinogram, perimetry, and spectral-domain optical coherence tomography. The primary outcome measure was single-surgery anatomical success (SSAS) at 12 weeks after primary surgery or after silicone oil removal. Secondary outcomes included BCVA changes and complication rates.
Results:
SSAS was achieved in 81.7% of all eyes, with a significantly higher success rate in eyes with PVR grade B compared to PVR grade C (93.1% versus 71.0%; p = 0.043). At 12 weeks, BCVA improved significantly in macula-off cases (p < 0.001) and remained stable in macula-on cases. In an exploratory subset of 17 patients postoperative multifocal electroretinogram and perimetry demonstrated preserved central retinal function. No ocular or systemic adverse events related to methotrexate occurred.
Conclusions:
The standardized intraoperative intravitreal methotrexate infusion protocol was safe, feasible, and associated with high single-surgery reattachment rates, particularly in PVR grade B eyes. Anatomical outcomes in PVR grade C eyes were comparable to other complex PVR cohorts, without any drug-related local or systemic toxicity.
Trial Registration:
Not applicable (retrospective observational study).