Intraocular methotrexate for the treatment of intraocular lymphoma

Purpose. To evaluate the efficacy and toxicity of intravitreal methotrexate in the treatment of intraocular lymphoma. Methods. Three patients with intraocular lymphoma were treated with intravitreal injections of methotrexate (400 micrograms/.1cc). Injections were given twice a week for 4 weeks, once a week for 4 weeks, and then monthly for 1 year. In addition patients with central nervous system lymphoma were treated with blood brain barrier disruption and intra-arterial chemotherapy. Treatment endpoints were a reduction or disappearance of anterior chamber and vitreous cells, and survival. Results. Five eyes of three patients have been treated. No patient has completed the treatment protocol; one patient is three weeks into the protocol, one is 8 weeks into the protocol and one is 12 weeks into the protocol. All treated eyes have had a reduction in the number of vitreous and anterior chamber cells. The principal toxicity has been corneal, with all eyes developing superficial punctate keratitis. Both eyes in one patient developed a filamentary keratitis that responded to topical leucovorin. In this patient the visual acuity in one eye dropped from 20/15 to 20/30, apparently due to the corneal changes. Conclusions. Our early results with intravitreal methotrexate indicate it is reasonably well tolerated and efficacious in treating intraocular lymphoma. It has potential advantages over radiation in that it may have less ocular toxicity, especially in patients that have recurrent disease after previous ocular or central nervous system radiation.