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