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Jacob Pe'er, Zohar Habot-Wilner, Shahar Frenkel; Treatment of vitreo-retinal lymphoma - 20 years of experience. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2777.
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© ARVO (1962-2015); The Authors (2016-present)
To describe our 20 years of experience in treating vitreoretinal involvement of primary central nervous system lymphoma, by intravitreal injections of methotrexate (MTX).
Intravitreal MTX (400 mg/0.05 ml) was administered twice weekly for 4 weeks, once weekly for 8 weeks, and then once monthly for 9 months, for a total of 25 injections. Data were collected from the patients’ records and included, inter alia, response to intravitreal MTX measured by time to disappearance of vitreal cells and retinal infiltrates, changes in visual acuity, and clinical recurrence rate.
130 eyes of 81 patients (49 women, 60.5%) were diagnosed at the mean age (±SD) of 62.0 ±16.9 years. 32 patients had monocular involvement and 49 had binocular. 35 (43.2%) patients also had CNSL and 5 (6.2%) had previous systemic lymphoma. Clinical remission was reached after 5.2 (±4.0) (1–16) injections of MTX (mean (±SD) (range)), with 90% of the eyes needing 11 injections or less to be cleared of malignant cells. Two patients had an intraocular recurrence which responded to the same treatment. Among the side effects, the most common was corneal epitheliopathy, which usually appeared after the third injection and began to subside when the intervals between injections increased. 13 patients (16.0%) developed NVG.
Vitreoretinal involvement of lymphoma can be controlled effectively and without serious adverse reactions by intravitreal MTX injections. This is an effective treatment protocol with bearable side effects. We recommend this as a standard of care in the management of vitreo-retinal lymphoma.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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