Intravitreal Methotrexate for the Treatment of Proliferative Vitreoretinopathy.

Jeffrey D. Benner, MD
John W. Butler, MD
Retina Consultants of Delmarva
Salisbury, MD 21804


This video shows a surgical technique used to treat patients with recurrent retinal detachment due to severe proliferative vitreoretinopathy (PVR). It involves the creation a 180° inferior relaxing retinectomy, the use of extended PFCL tamponade, with a series of 5 intravitreal methotrexate injections (over 10 wks).


Our patient is a 53 year old female whose retina redetached from PVR (Cp 6) after a previous scleral buckle and vitrectomy.  She also had a prominent macular pucker that was peeled at the time of the surgery.  Her retina was successfully reattached.  The PFLC was removed 5 weeks after this reattachment surgery. She underwent a series of 5 methotrexate injections (every two weeks over 10 weeks). 5 months later – her retina is reattached and her vision improved to 20/50.  At 7 months her retina is reattached 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.


We have a series of 5 other patients with longer follow-up (mean = 17.4 months). These patients also had recurrent retinal detachment is due to severe PVR.  They underwent the same surgical treatment and completed the series of 5 methotrexate injections over 10 weeks.  They have all done well and remained reattached – like this patient.  0 of 5 have re-detached.  The paper appeared in the April Edition of BMJ Open Ophthalmology:

YouTube Video 3:21 minutes

Benner JD, Dao D, Butler JW, et al. Intravitreal methotrexate for the treatment of proliferative vitreoretinopathy. BMJ Open Ophthalmology 2019;0:e000293. doi:10.1136/bmjophth-2019-000293