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S. Frenkel, T. Siegal, E. Shalom, J. Pe’er; Treatment of Vitreoretinal Lymphoma by Intravitreal Injections of Methotrexate. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3989.
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To describe our ten years of experience in treating vitreoretinal lymphoma by intravitreal injections of methotrexate (MTX).
Patients with suspected intraocular lymphoma underwent a diagnostic vitrectomy. Samples were sent for cytology, gene rearrangement and cytokine evaluation. Serum was collected for evaluation of cytokine levels. Positive results have led to treatment of patients by injections of 400 µg/0.1 ml methotrexate intravitreally under topical anesthesia. According to our protocol, injections are administered twice weekly for 4 weeks, once weekly for 8 weeks, and then once monthly for 9 months, for a total of 25 injections.
Over the past 10 years we have treated 45 eyes of 26 patients; 7 patients had monocular involvement, and 19 binocular. Twenty-three patients had B-cell lymphoma, and three had T-cell lymphoma. All patients had a complete response after a mean of 6 (range: 2 -16) injections of MTX . None of the patients had an intraocular recurrence. The most common side effects were hyperemia and corneal epitheliopathy, which usually appeared after the third injection and began to subside when the intervals between injections increased. Both the vitreal and serum samples showed a high IL-10 to IL-6 ratio, compatible with the diagnosis of lymphoma.
Vitreoretinal lymphoma can be controlled effectively and without serious adverse reactions by intravitreal MTX injections. The treatment protocol described herein has resulted in, so far, no intraocular recurrences and with bearable side effects.
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