title: INTRAVITREAL METHOTREXATE FOR MANTLE CELL LYMPHOMA INFILTRATION OF THE OPTIC NERVES: A CASE REPORT.
abstract: OBJECTIVE
  To report the successful treatment of a 78-year-old woman with bilateral mantle cell lymphoma involving the optic nerves. Chemotherapy initially was administered in the form of intravitreal methotrexate (MTX) monotherapy and was subsequently combined with systemic ibrutinib.
  
  
  METHODS
  Retrospective case report. The diagnosis of CD5-negative mantle cell lymphoma was confirmed via immunohistopathological analysis of an axillary lymph node. Serial ophthalmologic examinations in conjunction with fluorescein angiography, fundus photography, and spectral domain optical coherence tomography were used to assess the treatment response.
  
  
  RESULTS
  Prompt improvement in optic nerve infiltration, no significant side effects, and excellent tolerability were noted after two weekly injections of unilateral intravitreal MTX monotherapy. Combined systemic treatment with ibrutinib and bilateral weekly MTX intravitreal injections then resulted in continued regression of optic nerve infiltration bilaterally as confirmed by serial fundus photography and optical coherence tomography. After eight additional bilateral weekly injections, a mild MTX-associated keratopathy developed, which resolved promptly with cessation of injections and administration of topical lubrication. Six weeks after MTX cessation, but with continued ibrutinib treatment, the optic nerves revealed near-complete resolution of the lymphomatous infiltration and the visual acuity improved.
  
  
  CONCLUSIONS
  Intravitreal MTX injections and systemic ibrutinib may represent effective treatment options for patients diagnosed with intraocular mantle cell lymphoma.
authors.affiliation: Associated Retina Consultants, Phoenix, Arizona.
authors.forename: James R
authors.initials: JR
authors.lastname: Singer
authors.affiliation: Associated Retina Consultants, Phoenix, Arizona.
authors.forename: Archana K
authors.initials: AK
authors.lastname: Nigalye
authors.affiliation: Associated Retina Consultants, Phoenix, Arizona.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Champion
authors.affiliation: Associated Retina Consultants, Phoenix, Arizona.|The University of Arizona College of Medicine-Phoenix, Phoenix, Arizona.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Welch
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D058449:Intravitreal Injections; D020522:Lymphoma, Mantle-Cell / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008727:Methotrexate / Q000008:administration & dosage*; D009900:Optic Nerve / Q000473:pathology*; D019574:Optic Nerve Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D010880:Piperidines; D011720:Pyrazoles / Q000008:administration & dosage; D011743:Pyrimidines / Q000008:administration & dosage; D041623:Tomography, Optical Coherence / Q000379:methods; D014792:Visual Acuity; D014822:Vitreous Body
chemical_list: D000964:Antimetabolites, Antineoplastic; D010880:Piperidines; D011720:Pyrazoles; D011743:Pyrimidines; C551803:ibrutinib; D000225:Adenine; D008727:Methotrexate