Intraocular Lymphoma: Descriptive Data of 26 Patients Including Clinico-pathologic Features, Vitreous Findings, and Treatment Outcomes

Abstract

Intraocular lymphoma often masquerades as intraocular inflammation, resulting in delayed or misdiagnosis with subsequent inappropriate management. Optimal therapy is a challenge for oncologists and ophthalmologists.

Intraocular chemotherapy for vitreoretinal lymphoma: A review

“…Additional reports have described groups of patients suffering from VRL, who received a range of treatments that included methotrexate and/or rituximab intravitreal injections (see below). 4,22,[46][47][48] Outcomes reported for the 114 patients were consistent with those previously reported by the OHSU and Hadassah University investigators. 30 In summary, the treatment appeared to be highly effective at inducing ocular remission of the VRL, and was also used successfully to re-induce remission in cases of recurrent tumour.…”

“…Subsequent to the original clinical case series, medical centres in North America, Europe, the Middle East and Asia also have reported their experience in treating groups totalling at least 177 eyes of 114 patients with VRL, as well as multiple individual patients, using intravitreal methotrexate injections. Additional reports have described groups of patients suffering from VRL, who received a range of treatments that included methotrexate and/or rituximab intravitreal injections (see below) . Outcomes reported for the 114 patients were consistent with those previously reported by the OHSU and Hadassah University investigators .…”

“…Case reports and small series have detailed consistent experiences with intraocular rituximab therapy at ophthalmology centres in other countries, including Puerto Rico, Spain and Italy . In addition, a number of North American eye clinics have published outcomes of VRL patient cohorts cumulatively totalling almost 200 individuals, including some patients treated with intravitreal rituximab and/or methotrexate therapy; while these studies indicate treatment remissions, the impact of the local therapy specifically is not readily dissected since multiple approaches to treatment are included …”

“…In the study reported by Larkin et al, ophthalmologists administered at a frequency that varied from single or “as indicated” injections to 2‐monthly injections. While rituximab is administered intravitreally in the vast majority studies, one report from the Massachusetts Eye Research and Surgery Institution described intracameral injection of the drug . Hashida et al have reported on a waning in effectiveness of intravitreal rituximab injections: resistance is well described in the field of systemic lymphoma treatment, with various mechanisms proposed, including altered CD20 expression or signalling, increase in the apoptotic threshold of the lymphomatous cells, modulation of complement activity and/or reduced cellular cytotoxicity …”

“…[57][58][59] In addition, a number of North American eye clinics have published outcomes of VRL patient cohorts cumulatively totalling almost 200 individuals, including some patients treated with intravitreal rituximab and/or methotrexate therapy; while these studies indicate treatment remissions, the impact of the local therapy specifically is not readily dissected since multiple approaches to treatment are included. 4,22,[46][47][48] In 2014, Larkin et al 20 presented what is still the largest published experience with intraocular rituximab therapy to date, including 48 eyes of 34 patients, managed at clinics across five countries (ie, United States, Canada, Brazil, Germany and Australia). The most common dosing interval in these eyes was monthly, and a median of four injections were administered per eye.…”