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Purpose: This index study highlights the efficacy and safety of a combined surgical and medical therapy (with intraocular and systemic methotrexate) of pediatric rhegmatogenous retinal detachments (RRD) complicated by proliferative vitreoretinopathy (PVR)., Methods: Three pediatric patients with RRD complicated by PVR in the setting of underlying atopic dermatitis and/or uveitis who were treated with a combination of vitreoretinal surgery and intraoperative intravitreal methotrexate (MTX) (40mg) infusion, followed by at least one injection of 200 μg of MTX into the silicone oil-filled vitreous cavity, are reported. In addition, the patients received short-term systemic immunosuppression with systemic (oral or subcutaneous 20 mg weekly MTX for 12 weeks) and/or steroids., Results: Retinal reattachment with improvement in visual acuity was achieved in all eyes following a single surgery and remained to the final follow-up examination after oil removal. There were no observed side effects of intraocular or systemic MTX., Conclusions: The safety and efficacy of this combination therapy suggests that it could be a successful strategy for treating pediatric patients with RRD with or without PVR in the presence or absence of underlying inflammatory diseases., Competing Interests: Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

One new cardenolide, 3-O-β-D-allopyranosylcoroglaucigenin (salsotetragonin) (1), was isolated from the aerial parts of Salsola tetragona Delile with four known cardenolides (2-5); two known flavonoids (6-7), three known phenolic compounds (8-10) and two known fatty acids (11-12). Their structures were identified by spectroscopic analyses and by comparison of their spectral data with those reported in the literature. Compounds 1-5, 7, 10 and 12 were isolated from the genus Salsola for the first time. This is the first report on cardenolides identified in the Amaranthaceae family.