Intravitreal methotrexate injection for intraocular lymphoma: a retrospective review

Abstract

Objectives: To review the clinical outcomes of five patients with intraocular lymphoma (IOL) who were treated with intravitreal methotrexate (MTX) injections at the Hong Kong Eye Hospital after 2022.

Methods: We retrospectively reviewed medical records of five patients with definite or presumed IOL without systemic or central nervous system (CNS) involvement at the time of diagnosis, who were treated with intravitreal MTX injections.

Results: In total, eight eyes in one man and four women of Chinese ethnicity aged 54 to 90 (mean, 68.4) years underwent intravitreal MTX injections for IOL. Three patients had primary IOL; one patient had a relapse of diffuse large B-cell lymphoma with secondary IOL; and one patient had a relapse of primary CNS lymphoma with ocular involvement. All five patients underwent diagnostic pars plana vitrectomy. Definitive cytology of malignant large B-cell lymphoma was achieved in only one eye, whereas four eyes were diagnosed cytologically with a lymphoproliferative lesion. All patients received local intravitreal MTX injections with a mean of 20.9 injections given to each eye. All patients achieved ocular disease regression; however, two patients with primary IOL eventually had CNS involvement.

Conclusion: Primary IOL carries a high risk of CNS disease progression. Local ocular treatments such as intravitreal MTX injections can effectively control the disease locally but do not prevent or treat CNS or systemic involvement. Monitoring by a multidisciplinary team using magnetic resonance imaging, positron emission tomography-computed tomography, and/or lumbar punctures can detect CNS or systemic disease early.