Acupuncture resulting in eye penetration and proliferative vitreoretinopathy – Surgical and medical management with intraocular methotrexate

PURPOSE: To highlight the surgical and medical management used in an extensive globe penetrating injury caused by an acupuncture needle. OBSERVATIONS: We report on a case of acupuncture treatment error resulting in needle penetration of the eye, retinal detachment, and progressive post-traumatic proliferative vitreoretinopathy (PVR). This patient required aggressive surgical management with multiple vitrectomies along with adjunctive intravitreal methotrexate to control ongoing PVR. At last follow-up, 15 months after presentation, the patient's BCVA was 20/40 and the periphery was flat with fibrosis stable. CONCLUSIONS AND IMPORTANCE: Open globe injuries are a subtype of ocular trauma which can cause irreparable vision loss. This case highlights the extensive potential complications which can occur following traumatic injury to the retina and choroid, as well as the role of both surgical and medical management of retinal detachment and PVR. In addition, this is the first report of the use of off-label adjunctive intravitreal methotrexate to control post-traumatic PVR. Further research into this treatment approach could reveal a role of adjunctive methotrexate in the management of such injuries.