Intra-vitreal Chemotherapy for Vitreoretinal Lymphoma

Vitreoretinal lymphoma (VRL) is the most common type of intraocular lymphoma. It is a high-grade B-cell lymphoma, and is often associated with central nervous system lymphoma (CNSL). The hallmark of VRL is the presence of lymphoma cells in the vitreous and retinal and sub-retinal infiltrates. Systemic chemotherapy and radiation therapy have been used for years to treat VRL. In the recent two decades, intra-vitreal chemotherapy as monotherapy or combined with systemic chemotherapy has become a common method for treating VRL. Methotrexate is the most common drug used for intra-vitreal chemotherapy with a very good response, rare intraocular recurrence of the disease (when following the treatment protocol) and acceptable side effects. When CNSL is associated with VRL, systemic chemotherapy is used for the brain disease. Intra-vitreal injections of rituximab have also been used with encouraging results and almost no adverse effects. Limited experience with intra-vitreal injections of other drugs also was found to be effective for the cure of VRL. Other drugs have been experimentally tested in animal models and may be used in the future.