Intravitreal Methotrexate and CAR-T Therapy for Anterior Segment B-Cell Acute Lymphoblastic Leukemia Relapse

The authors present a child with a rare case of unilateral pseudo-hypopyon and raised intraocular pressure as the only manifestation of acute lymphoblastic leukemia recurrence. This was treated with intravitreal methotrexate and chimeric antigen receptor T-cell therapy (CAR-T) with subsequent remission. This case demonstrates intravitreal methotrexate is a safe and effective adjunct to use with CAR-T therapy for relapsing acute lymphoblastic leukemia with ocular involvement. Further research should be sought on both CAR-T therapy and intravitreal methotrexate for acute lymphoblastic leukemia with ocular involvement. [J Pediatr Ophthalmol Strabismus. 2025;62(2):e18-e21.].