Outcomes of Complex PVR Retinal Detachment Repair With and Without Intravitreal Methotrexate at a Single Tertiary Care Center

Background and Objective: Proliferative vitreoretinopathy (PVR) remains the leading cause of failed retinal detachment (RD) repair. This study evaluated anatomic and visual outcomes in complex Grade C PVR RDs by advanced vitreoretinal techniques with or without adjunctive intravitreal met hotrexate (MTX). Patients and Methods: This retrospective consecutive case series included eyes undergoing surgical repair at a single tertiary care center. Outcomes were compared in complex RDs repaired by advanced surgical maneuvers with or without adjunctive MTX. The primary endpoint was single-surgery retinal attachment, assessed at 3 to 5 months, 1 year, and final follow-up. Secondary endpoints included visual acuity (VA), outcomes after silicone oil removal, and corneal epitheliopathy. Results: There were no significant difference in single-surgery retinal reattachment rates ( P = 1.00) or VA ( P > 0.05) at any timepoint. The number of MTX injections was not associated with improved odds of single-surgery reattachment ( OR = 1.02, P = 0.73). Mild corneal epitheliopathy was observed in 28.8% of MTX-treated eyes. Conclusion: Adding intravitreal MTX to advanced vitreoretinal repair techniques did not show significant improvement in the outcomes of complex Grade C PVR RDs. Additional refinement of treatment criteria is likely needed to identify which patients may benefit the most from this additional treatment.