Korean J Ophthalmol.  2009 Sep;23(3):210-214. 10.3341/kjo.2009.23.3.210.

A Case of Primary Intraocular Lymphoma Treated by Intravitreal Methotrexate

• Kim E
• Kim C
• Lee J
• Cho Y

• KMID: 1115756
• DOI: http://doi.org/10.3341/kjo.2009.23.3.210

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 microgram/0.1 ml in the right eye, 400 microgram/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.

Keyword

Intravitreal injection; Masquerade syndrome; Methotrexate; Primary intraocular lymphoma; Uveitis

MeSH Terms

Adult
Antimetabolites, Antineoplastic/*administration & dosage
Drug Administration Schedule
Eye Neoplasms/*drug therapy
Female
Humans
Injections
Lymphoma/*drug therapy
Methotrexate/*administration & dosage
Treatment Outcome
Vitreous Body

Figure

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  Fig. 1 (A) Fluorescein angiography; some perivascular dye leakage, disc hyperfluorescence and granular patterns of scattered hypofluorescent and hyperfluorescent spots are seen in the right eye. (B) Visual field of the right eye; considerable peripheral constriction is seen in pattern deviation. (C) OCT of the right eye; small RPE humps are seen.

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  Fig. 2 Multifocal ERG; trace arrays and 3D-topography ofthe response density in the right eye shows prominent suppression of the central signal compared with that of the left eye.

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  Fig. 3 Fluorescein angiography shows a granular pattern and leakage from vessels in the left eye.

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  Fig. 4 (A) H-E stain of the preretinal membrane shows a diffuse infiltration of atypically large lymphoid cells (×400). (B) CD20 immunostaining shows diffuse strong immunoreactivities in the tumor cells (×400).

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  Fig. 5 Toxic epithelial keratopathy is seen in both eyes.

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  Fig. 6 Fluorescein angiography shows a persistent granular pattern but no dye leakage.

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