Management of non Hodgkin's intraocular lymphoma with intravitreal methotrexate

Intraocular non Hodgkin's lymphoma has traditionally been treated with radiotherapy or systemic chemotherapeutic agents. Unfortunately, radiotherapy rarely leads to a long term remission, and can only be safely administered once. Systemic chemotherapy has limited intraocular penetration. Intravitreal administered methotrexate is highly effective at inducing remission and is well tolerated. A case report is presented of a recurrent intraocular lymphoma following radiotherapy and systemic chemotherapy which responded to a combination of intravitreal methotrexate and dexamethasone. A response was seen within three weeks of treatment initiation. Toxicity was limited to the progression of a pre-existing cataract. Review of the literature shows that intravitreal methotrexate is well tolerated, with few acute complications. However, with monotherapy, local recurrences have been observed.