Comparison of per operative methotrexate infusion with postoperative intra silicon oil methotrexate injections for prevention of proliferative vitreoretinopathy development after vitrectomy for rhegmatogenous retinal detachment repair

Abstract

Objective: To compare the efficacy of repeated intrasilicon oil methotrexate injections with methotrexate infusion during pars plana vitrectomy in preventing proliferative vitreoretinopathy (PVR) development.

Methodology: This randomized controlled trial was conducted at Sahiwal Teaching Hospital, Sahiwal and Ali Fatima Teaching Hospital Lahore from March 2024 to May 2025. Study included patients of rhegmatogenous retinal detachment of both genders from 20 to 70 years of age. Patients were divided into two groups with 60 subjects in each group. Group one was regarded as control group where per operative methotrexate (MTX) infusion was used. Group two was regarded as the study group that received repeated injections of intra-silicon oil MTX. Primary outcomes were proliferative vitreoretinopathy (PVR) development and retinal re-detachment at three months. Secondary outcome was visual acuity improvement.

Results: There were 66(55%) male and 54(45%) female patients. Postoperatively visual acuity improved in 48(80%) cases in group one and 44(73.3%) cases in group two. PVR developed in 6(10%) patients in group one while no patient developed PVR in group two. Recurrent retinal detachment occurred in 8(13.3%) cases in group one and 2(3.3%) cases in group two. Chi-square test showed that there was statistically significant difference between the two groups in the development of PVR and retinal re-detachment (p<0.05).

Conclusion: Repeated intra-silicon oil injections of MTX are more effective than intraoperative infusion of MTX in preventing the development of PVR and decreasing the rate of retinal re-detachment.