Maculopathy in patients with primary CNS lymphoma treated with chemotherapy in conjunction with blood-brain barrier disruption.
OBJECTIVE
To determine the incidence and characteristics of maculopathy associated with blood-brain barrier disruption (BBBD) which is used in treating primary central nervous system lymphoma (PCNSL).


METHODS
Files of all 56 patients with PCNSL, with or without intraocular lymphoma (IOL), treated at Hadassah University Hospital during the years 1997-2007 were reviewed. Data on 46 patients for whom we had documentation of ocular examination were studied. Those who were alive at the time of the data collection were invited for further evaluation of the presence or absence of maculopathy. The patients were divided into four groups according to treatment protocol. Group 1: systemic intravenous chemotherapy; Group 2: systemic intravenous chemotherapy and intravitreal methotrexate (MTX); Group 3: systemic intra-arterial (IA) chemotherapy and BBBD; Group 4: systemic IA chemotherapy, BBBD, and intravitreal MTX.


RESULTS
Of the 23 patients of Groups 1 and 2 who were not treated by BBBD, none developed maculopathy. Of those 23 patients who were treated by BBBD, 12 of 17 (70.5%) in Group 3 and three of six (50%) in Group 4, for a total of 15 of 23 (65.2%) developed maculopathy. The maculopathy did not significantly affect visual acuity in any of them.


CONCLUSIONS
BBBD may cause maculopathy in almost two-thirds of patients treated for PCNSL, without affecting significantly the visual acuity. Intravitreal injection of MTX, according to the protocol which we apply, is not associated with maculopathy.
Vicuna-Kojchen
J
J
Department of Ophthalmology, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel.
Frenkel
S
S
Siegal
T
T
Shalom
E
E
Chowers
I
I
Pe'er
J
J
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001812:Blood-Brain Barrier / Q000000981:diagnostic imaging / Q000187:drug effects; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D016543:Central Nervous System Neoplasms / Q000188:drug therapy*; D005134:Eye Neoplasms / Q000188:drug therapy; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007267:Injections; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008266:Macula Lutea / Q000187:drug effects / Q000473:pathology*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D012164:Retinal Diseases / Q000139:chemically induced* / Q000503:physiopathology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014822:Vitreous Body
D016190:Carboplatin; D008727:Methotrexate