Article Text

Download PDFPDF
Outcomes of intravitreal methotrexate to salvage eyes with relapsed primary intraocular lymphoma
  1. Mona Mohammad1,2,
  2. Richard M Andrews1,3,4,
  3. P Nicholas Plowman5,
  4. Gordon Hay1,4,
  5. Amit K Arora1,4,
  6. Victoria M L Cohen1,4,
  7. Mandeep S Sagoo1,3,4,5,6
  1. 1 Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  2. 2 Ocular Oncology Service, King Hussein Cancer Center, Amman, Jordan
  3. 3 Medical Retina Service, Moorfields Eye Hospital, London, UK
  4. 4 NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
  5. 5 Department of Medical Oncology, St Bartholomew’s Hospital, London, UK
  6. 6 UCL Institute of Ophthalmology, London, United Kingdom
  1. Correspondence to Mandeep S Sagoo, Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, City Road, London EC1V 2PD, UK; mandeep.sagoo1{at}nhs.net

Abstract

Purpose To report the outcomes of intravitreal methotrexate (MTX) injections to rescue eyes with relapsed primary intraocular lymphoma (PIOL).

Methods Retrospective case series of patients with ocular relapse of PIOL who had initially received systemic chemotherapy (all five cases) and external beam radiotherapy (EBRT) to brain and orbits (two cases). Injections of MTX (400 µg/0.1 mL) were given one time per week for 1 month, every other week for 4 months, followed by a maintenance phase of one injection one time per month for 8 months (total of 20 injections in a year).

Results From April 2008 to February 2016, there were nine eyes of five patients (three men; average age at first presentation 62 years) treated with our rescue protocol of intravitreal MTX injections. Ocular relapse occurred at a mean interval of 15 months (range 5–34 months) after the completion of initial systemic treatment. At mean follow-up of 31 months (range 5–104 months), tumour control was achieved in eight out of nine eyes (89%); one eye failed, with persistent retinal infiltrates despite increasing the frequency of injections, resulting in severe keratopathy. The only other complication occurred in one eye, developing cystoid macular oedema from MTX injections that resolved with topical anti-inflammatory medications and reduced frequency of MTX. There were no cases of reduced vision or ocular relapse, but two patients died (one of central nervous system lymphoma).

Conclusions Intravitreal MTX was a safe and effective treatment modality for relapsed PIOL after systemic chemotherapy and radiotherapy, achieving local tumour control in 89%, and hence represents an optimal choice. However, given the rare nature of PIOL, larger collaborative studies with longer follow-up are needed to corroborate this.

  • Not applicable
  • Retina
  • Vitreous

Presented in part at the 52nd Annual Scientific Meeting of the Retina Society, London, UK, September 2019.

View Full Text

Statistics from Altmetric.com

Presented in part at the 52nd Annual Scientific Meeting of the Retina Society, London, UK, September 2019.

View Full Text

Footnotes

  • Presented in part at the 52nd Annual Scientific Meeting of the Retina Society, London, UK, September 2019.

  • Contributors MSS and MM had substantial contribution to the design of the work, collection and analysis of the data; drafting the work; final approval of the version published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. RA had substantial contribution to the acquisition, collection and analysis of the work; drafting the work; final approval of the version published and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. NP, GH, AKA and VMLC had substantial contribution to the conception of the work, collection and analysis of the data, drafting the work, approval of the version published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.