Efficacy and safety of intravitreal methotrexate for vitreo-retinal lymphoma – 20 years of experience
Zohar Habot-Wilner
Uveitis Service, Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Search for more papers by this authorCorresponding Author
Shahar Frenkel
Ocular Oncology Service, Division of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
Ocular Oncology and Ophthalmic Pathology Laboratory, The Wohl Institute for Translational Medicine, Hadassah Medical Center, Jerusalem, Israel
Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
Equal contribution as the last author.
Correspondence: Shahar Frenkel, Division of Ophthalmology, Hadassah Medical Center, Kiryat Hadassah, PO Box 12000, Jerusalem, 91120, Israel.
E-mail: [email protected]
Search for more papers by this authorJacob Pe’er
Ocular Oncology Service, Division of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
Equal contribution as the last author.
Search for more papers by this authorZohar Habot-Wilner
Uveitis Service, Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Search for more papers by this authorCorresponding Author
Shahar Frenkel
Ocular Oncology Service, Division of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
Ocular Oncology and Ophthalmic Pathology Laboratory, The Wohl Institute for Translational Medicine, Hadassah Medical Center, Jerusalem, Israel
Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
Equal contribution as the last author.
Correspondence: Shahar Frenkel, Division of Ophthalmology, Hadassah Medical Center, Kiryat Hadassah, PO Box 12000, Jerusalem, 91120, Israel.
E-mail: [email protected]
Search for more papers by this authorJacob Pe’er
Ocular Oncology Service, Division of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
Equal contribution as the last author.
Search for more papers by this authorThe retrospective collection of patients’ data was approved by the Institutional Review Board of both institutions.
Summary
Vitreo-retinal lymphoma (VRL) is the most common intraocular lymphoma and is highly associated with central nervous system (CNS) lymphoma (CNSL), both posing a therapeutic challenge. We investigated patients’ characteristics, efficacy and safety of intravitreal methotrexate (MTX) injections and their outcomes over 20 years. The records of 129 patients diagnosed between 1997 and 2018 were retrospectively reviewed. Lymphoma involved both the CNS and vitreo-retina (49%), solely the CNS (37%) or solely the vitreo-retina (14%). In all, 45·5% of the patients with CNSL either presented with VRL or developed it after a mean (±SE) of 85·7 (7·3) months. In all, 66·0% of the patients diagnosed with VRL either presented with CNSL or developed it after a mean (±SE) 42·6 (7·6) months. The 81 patients with VRL (134 eyes) received a mean (±SD) of 19 (7) injections; however, only 5 (4) injections were needed to reach complete remission. Local recurrence occurred in two of the 81 patients. Overall, 80·2% of eyes had an initial moderate–severe visual loss, and >50% of them improved. Reversible keratopathy was the most prevalent side-effect. A total of 18·5% developed intraocular pressure (IOP) elevation due to angle neovascularisation after 16 injections, which could be reversed with prompt intravitreal injection of bevacizumab. Intravitreal MTX injections are a safe and effective treatment for VRL. Fewer injections (15) may offer similar results with fewer side-effects.
Conflict of interest
The authors have no competing interests.
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