Eye protected by glowing shield, symbolizing IMI treatment for retinal detachment

Can a Simple Infusion Protect Your Sight? The PVR Breakthrough You Need to Know

Theo Raines in Health & Wellness August 2025 • 4 min read.

"Intravitreal Methotrexate Infusion: A Promising Strategy for High-Risk Retinal Detachment Patients"

Proliferative vitreoretinopathy (PVR) is a condition where membranes form and contract within the eye, leading to retinal detachment (RD). It's a significant challenge, affecting 5-10% of RD patients and contributing to 75% of failed RD repairs. The process begins when retinal pigment epithelial (RPE) cells migrate to unusual locations, leading to further complications.

Traditionally, anti-inflammatory drugs like corticosteroids have been used alongside retinal reattachment surgery to prevent PVR. Ocular inflammation is a known risk factor. However, the effectiveness of these treatments has been inconsistent, leading researchers to explore new approaches.

Now, a promising solution is emerging: intravitreal methotrexate infusion (IMI). This article dives into a study evaluating IMI during pars plana vitrectomy (PPV) for patients at high risk of developing PVR, revealing its potential to improve outcomes and protect vision.

How Does Intravitreal Methotrexate Infusion (IMI) Work?

Eye protected by glowing shield, symbolizing IMI treatment for retinal detachment

Methotrexate (MTX) is a well-established antineoplastic agent that inhibits enzymes essential for DNA synthesis. Lower concentrations of MTX also treat chronic inflammatory conditions like rheumatoid arthritis by promoting the anti-inflammatory agent adenosine.

MTX may also have direct anti-fibrotic effects, impacting collagen production. This multifaceted approach makes MTX a potential blocker of various aspects of PVR, including:

Aberrant cell proliferation
Inflammation
Fibrosis

In ophthalmology, intraocular MTX has been used to treat inflammatory conditions, while higher doses treat intraocular lymphoma. Its safety record is generally excellent, although some side effects have been reported with multiple injections.

Is IMI the Future of PVR Prevention?

The Cincinnati Eye Institute study revealed promising results. Out of 29 eyes at high risk for PVR, a single IMI dose during PPV led to retinal reattachment in 90% of cases. Visual acuity improved or remained stable in 83% of eyes, with 66% achieving 20/200 vision or better after six months. Importantly, no complications directly attributable to IMI were observed.

The study also highlighted cases where patients with a history of PVR in one eye did not develop it in the fellow eye after receiving IMI. This suggests a preventative potential, especially for those at high risk.

While these findings are encouraging, the study was a small, uncontrolled, retrospective pilot series. The authors call for a more rigorous, controlled, prospective study to confirm IMI's efficacy and identify ideal candidates for this treatment. For individuals at high risk of PVR, IMI shows promise as a valuable tool in preserving vision and improving outcomes after retinal detachment surgery.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.2147/opth.s111893, Alternate LINK

Title: Intravitreal Methotrexate Infusion For Proliferative Vitreoretinopathy

Subject: Ophthalmology

Journal: Clinical Ophthalmology

Publisher: Informa UK Limited

Authors: Ama Sadaka, Robert Sisk, James Osher, Okan Toygar, Melinda Duncan, Christopher Riemann

Published: 2016-09-01

Everything You Need To Know

What exactly is proliferative vitreoretinopathy (PVR), and why is it such a serious concern in retinal detachment cases?

Proliferative vitreoretinopathy (PVR) is a condition where membranes form and contract inside the eye. This process leads to retinal detachment. PVR is a significant challenge because it affects 5-10% of retinal detachment patients and contributes to 75% of failed retinal detachment repairs. The root cause involves retinal pigment epithelial (RPE) cells migrating to unusual locations, which triggers further complications.

How does intravitreal methotrexate infusion (IMI) actually work to combat proliferative vitreoretinopathy (PVR) at a cellular level?

Intravitreal methotrexate infusion (IMI) works through the actions of methotrexate (MTX). MTX, an antineoplastic agent, inhibits enzymes crucial for DNA synthesis. At lower concentrations, MTX treats chronic inflammatory conditions by boosting the anti-inflammatory agent adenosine. MTX also has direct anti-fibrotic effects, impacting collagen production. This multifaceted approach allows MTX to block aberrant cell proliferation, inflammation and fibrosis associated with PVR.

What were the key findings of the Cincinnati Eye Institute study regarding the success rates and visual outcomes of using intravitreal methotrexate infusion (IMI) for high-risk PVR patients?

The Cincinnati Eye Institute study indicated that a single intravitreal methotrexate infusion (IMI) dose during pars plana vitrectomy (PPV) resulted in retinal reattachment in 90% of eyes at high risk for proliferative vitreoretinopathy (PVR). Furthermore, visual acuity either improved or remained stable in 83% of eyes. 66% achieved 20/200 vision or better after six months. Notably, there were no observed complications directly related to IMI.

How is intravitreal methotrexate infusion (IMI) administered in conjunction with the pars plana vitrectomy (PPV) procedure, and why is this approach preferred?

Intravitreal methotrexate infusion (IMI) is administered during a pars plana vitrectomy (PPV), a surgical procedure used to treat various retinal conditions including retinal detachment and proliferative vitreoretinopathy (PVR). During PPV, the vitreous gel is removed from the eye, allowing the surgeon to access and repair the retina. The IMI is then injected directly into the vitreous cavity. The timing of IMI administration during PPV allows for direct targeting of retinal cells with methotrexate (MTX), maximizing its therapeutic effect while minimizing systemic exposure.

What aspects of treating proliferative vitreoretinopathy (PVR) with intravitreal methotrexate infusion (IMI) were not addressed, and what future research could help improve our understanding and application of this treatment?

While the study focuses on the effectiveness of intravitreal methotrexate infusion (IMI) during pars plana vitrectomy (PPV), it doesn't delve into the long-term effects or compare IMI to other emerging treatments. The study also does not discuss combination therapies, such as combining IMI with other anti-inflammatory agents or novel anti-fibrotic drugs. Future research should investigate these aspects to fully understand the potential and limitations of IMI in treating proliferative vitreoretinopathy (PVR). Further investigation could explore personalized approaches, tailoring the dosage and timing of IMI based on individual patient risk factors and disease severity.