A Case of Primary Intraocular Lymphoma Treated by Intravitreal Methotrexate
Eunah Kim, MD,1Changhyun Kim, MD,1Jiwoong Lee, MD,2
and Youngwook Cho, MD1
1Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea.
2Department of Ophthalmology, School of Medicine, Pusan National University, Busan, Korea.
Reprint requests to Youngwook Cho, MD. Department of Ophthalmology, Fatima Hospital, #576-31 Sinam-dong, Dong-gu, Daegu 701-600, Korea. Tel: 82-53-940-7143, Fax: 82-53-954-7417, Email: vitreo-retina@hanmail.net
Received October 13, 2008; Accepted August 07, 2009.
Abstract
A 40-year-old female visited our clinic for visual disturbance of the right eye, in which a few creamy-yellow retinal lesions and visual field constrictions were noted. She had been treated for primary CNS lymphoma and was in complete remission. After failure to follow-up for three months, she lost vision in the right eye, at which time active panuveitis was seen. Decreased vision and field constriction was observed in the left eye. Her left eye showed a granular pattern and dye leakage from the vessels and disc on fluorescein angiography and small RPE humps were seen in optical coherence tomography (OCT). Diffuse large malignant B-cells with strong immunoreactivities with CD20 immunostaining were seen in the epiretinal membrane biopsy specimen. Intravitreal injections of methotrexate (MTX) (800 µg/0.1 ml in the right eye, 400 µg/0.05 ml in the left eye) were performed twice weekly for one month, once weekly for the following month, once every two weeks for the next month, followed by nine monthly injections. Both eyes were free from malignant cells on vitreous biopsy six months later. There was no leakage seen by angiography, but the granular pattern persisted. Visual field constriction was slightly improved, and the small RPE humpsdetachments seen in OCT disappeared. EOG Arden ratio was decreased in both eyes, and b wave amplitude of scotopic ERG was decreased in the left eye. She was free from recurrence until six months later. No ocular complications except minimal opacity of the crystalline lenses were noted in both eyes.
Peterson K,Gordon KB,Heinemann MH,DeAngelis LM. The clinical spectrum of ocular lymphoma. Cancer 1993;72:843–849.
3.
Davis JL. Diagnosis of intraocular lymphoma. Ocul Immunol Inflamm 2004;12:7–16.
4.
Nussenblatt RB,Chan CC,Wilson WH,et al. International Central Nervous System and Ocular Lymphoma Workshop: recommendations for the future. Ocul Immunol Inflamm 2006;14:139–144.
5.
Hochberg FH,Miller DC. Primary central nervous system lymphoma. J Neurosurg 1988;68:835–853.
6.
Lee SH,Kim DJ,Kim IT. A Case of Primary Central Nervous System Lymphoma with Ocular Involvement. J Korean Ophthalmol Soc 2005;46:565–571.
7.
Nelson DF,Martz KL,Bonner H,et al. Non-Hodgkin's lymphoma of the brain: can high dose, large volume radiation therapy improve survival? Report on a prospective trial by the Radiation Therapy Oncology Group (RTOG): RTOG 8315. Int J Radiat Oncol Biol Phys 1992;23:9–17.
8.
Batchelor TT,Kolak G,Ciordia R,et al. High-dose methotrexate for intraocular lymphoma. Clin Cancer Res 2003;9:711–715.
9.
Berenbom A,Davila RM,Lin HS,Harbour JW. Treatment outcomes for primary intraocular lymphoma: implications for external beam radiotherapy. Eye 2007;21:1198–1201.
10.
Margolis L,Fraser R,Lichter A,Char DH. The role of radiation therapy in the management of ocular reticulum cell sarcoma. Cancer 1980;45:688–692.
11.
Sou R,Ohguro N,Maeda T,et al. Treatment of primary intraocular lymphoma with intravitreal methotrexate. Jpn J Ophthalmol 2008;52:167–174.
12.
Frenkel S,Hendler K,Siegal T,et al. Intravitreal methotrexate for treating vitreoretinal lymphoma: 10 years of experience. Br J Ophthalmol 2008;92:383–388.
13.
Behin A,Hoang-Xuan K,Carpentier AF,Delattre JY. Primary brain tumours in adults. Lancet 2003;361:323–331.
Ursea R,Heinemann MH,Silverman RH,et al. Ophthalmic, ultrasonographic findings in primary central nervous system lymphoma with ocular involvement. Retina 1997;17:118–123.
16.
Corriveau C,Easterbrook M,Payne D. Lymphoma simulating uveitis (masquerade syndrome). Can J Ophthalmol 1986;21:144–149.