Intravitreal Melphalan Injection as a Second-line Local Therapy in Vitreoretinal Lymphoma: Case series

Abstract

Purpose: To evaluate the effectiveness and safety of intravitreal Melphalan(IVM) injection therapy in vitreoretinal lymphoma(VRL). Methods: Eight eyes of 5 biopsy-proven VRL patients who were treated with IVM injection as a second-line therapy after intravitreal Methotrexate(IVMTX) and Rituximab(IVR) injections were retrospectively evaluated between January 2011 and March 2023. Results: The medical records of five VRL patients (mean age of 62 years at the diagnosis) including four(80%) females and one(20%) male were retrospectively analyzed. Three patients(60%) either had a history of central nervous lymphoma or developed it during the follow-up. Patients were previously treated with a mean of 5 cycles of monthly IVMTX and IVR injections. All eyes showed complete response by the disappearance of vitreal and/or subretinal neoplastic cells within six weeks after IVM injections(range, 1-4 injections/eye). Of 12 IVM injections, three(25%) injections were associated with macular edema diagnosed on optical coherence tomography at one-month follow-up and resolved spontaneously within 5 months. The IVM administration induced new retinal pigment epithelium changes in 3 eyes(37%). Conclusion: IVM injection may be effective in the management of VRL as second-line local therapy. Randomized clinical trials with larger numbers of patients are needed to establish the efficacy, treatment protocol, and safety of IVM injection.