Program Book

Specialized Ocular Oncology Service, Department of Ophthalmology
Hadassah - Hebrew University Medical Center, Kiryat Hadassah,
Jerusalem, Israel
Purpose. Vitreoretinal lymphoma is the most common type of intraocular
lymphoma, and in most cases accompanies CNS lymphoma. Radiation
therapy and systemic chemotherapy are the traditional methods
of treating vitreoretinal lymphoma, but in recent years intravitreal
chemotherapy has been used successfully in several centers.
Methods. Since 1997 we have treated all our patients with vitreoretinal
lymphoma by intravitreal injections of 400 µg/0.1 ml methotrexate
alone. Our protocol includes twice-weekly injections for 4 weeks, a
weekly injection for 8 weeks, and a monthly injection for 9 months, for
a total of 25 injections.
Results. Over the last 14 years we have treated 80 eyes of 45 patients;
in three-quarters of them the disease was bilateral. In 41 patients the
lymphoma was of the B-cell type, and in 4 the T-cell type. In one-third of
the patients the vitreoretinal lymphoma preceded the CNS lymphoma,
and in the rest the brain lymphoma was diagnosed earlier. All our
patients responded to the treatment with total disappearance of the
lymphoma cells from the vitreous and the infiltrates from the retina after
3 – 16 injections. In all but one patient no recurrence was noticed. In
one patient recurrence was diagnosed in one of the two affected eyes,
and was treated again by our protocol, with complete response. Irritated
conjunctiva and corneal epitheliopathy were the most common side
effects. Four patients, two of them diabetics, developed neovascular
glaucoma that recently was treated using intravitreal injections of
Avastin.
Conclusions. Intravitreal injection of methotrexate is a very successful
method of treating vitreoretinal lymphoma, with almost no recurrence
and reasonable ocular side effects.
Financial disclosure. None.
EYELID, CONJUNTIVA & ORBIT
Abstracts
74
2329 OT12
COMBINATION INTRAVITREAL RITUXIMAB AND
METHOTREXATE FOR PRIMARY VITREORETINAL
LYMPHOMA
David J. Wilson, MD and Justine Smith, MD, PhD (wilsonda@ohsu.edu)
Casey Eye Institute, Oregon Health and Science University
Purpose. To determine the response rate and ocular effects of monthly
intravitreal injection of a combination of methotrexate and rituximab in
the treatment of primary vitreoretinal lymphoma.
Methods. This is a retrospective chart review of a consecutive case series
from one institution of patients with primary vitreoretinal lymphoma that
were treated with combined methotrexate (.4mg/.1ml.) and rituximab (1
mg/.1ml) by intravitreal injection. Injections were given on a monthly
basis. Inclusion criteria consisted of biopsy proven vitreous or CNS.
CD20 positive lymphoma.
Results. Ten patients met the inclusion criteria. Five patients achieved
a complete remission (defined as complete absence of vitreous cellsor
sub RPE infiltrates). Five patients achieved partial remission (defined
as markedly reduced but still detectable vitreous cells). Median follow
up is 11 months. No ocular side effects directly attributable to the
intravitreous agents were detected.
Conclusions. Intravitreal injection of a combination of Rituximab and
Methotrexate apppears to be a safe method for inducing partial or
complete remission of a high percentage of patients with primary
vitreoretinal lymphoma.
Financial disclosure. None