Korean J Ophthalmol Vol.23, No.3, 2009 OD OS Fig. 6. Fluorescein angiography shows a persistent granular pattern but no dye leakage. Intravitreal chemotherapy has been reported to have few com- plications,11,12 and because MTX is well tolerated by intraocular tissues, repeated injections are feasible without retinal toxicity.19 Toxic keratopathy can also be easily managed with topical leu- covorin eye drops and lubricants. We modified the chemotherapy protocol of a previous report12 by adding two additional once-every-two-week injections for consolidation because the patient had useful vision in only one eye and any other treatment choice was not readily available. We also used a double dose regimen in the right eye where tumor involvement of the vitreous and retina was massive, no useful vision remained, and, being a vitrectomized eye, a shorter half-life of MTX was expected. Intravitreal chemotherapy was effective even though the patient had a history of systemic che- motherapy failure for PCNSL. In summary, primary intravitreal chemotherapy can be effec- tively used to treat PIOL and had minimal ocular complica- tions in this patient. References 1. Chan CC, Buggage RR, Nussenblatt RB. Intraocular lymphoma. Curr Opin Ophthalmol 2002;13:411-8. 2. Peterson K, Gordon KB, Heinemann MH, DeAngelis LM. The clinical spectrum of ocular lymphoma. Cancer 1993;72:843-9. 3. Davis JL. Diagnosis of intraocular lymphoma. Ocul Immunol In- flamm 2004;12:7-16. 4. Nussenblatt RB, Chan CC, Wilson WH, et al. International Central Nervous System and Ocular Lymphoma Workshop: recommen- dations for the future. Ocul Immunol Inflamm 2006;14:139-44. 5. Hochberg FH, Miller DC. Primary central nervous system lym- phoma. J Neurosurg 1988;68:835-53. 6. Lee SH, Kim DJ, Kim IT. ACase of Primary Central Nervous Sys- tem Lymphoma with Ocular Involvement. J Korean Ophthalmol 214 Soc 2005;46:565-71. 7. Nelson DF, Martz KL, Bonner H, et al. Non-Hodgkin’s lymphoma of the brain: can high dose, large volume radiation therapy im- prove survival? Report on a prospective trial by the Radiation The- rapy Oncology Group (RTOG): RTOG 8315. Int J Radiat Oncol Biol Phys 1992;23:9-17. 8. Batchelor TT, Kolak G, Ciordia R, et al. High-dose methotrexate for intraocular lymphoma. Clin Cancer Res 2003;9:711-5. 9. Berenbom A, Davila RM, Lin HS, Harbour JW. Treatment out- comes for primary intraocular lymphoma: implications for external beam radiotherapy. Eye 2007;21:1198-201. 10. Margolis L, Fraser R, Lichter A, Char DH. The role of radiation therapy in the management of ocular reticulum cell sarcoma. Cancer1980;45:688-92. 11. Sou R, Ohguro N, Maeda T, et al. Treatment of primary intraocular lymphoma with intravitreal methotrexate. Jpn J Ophthalmol 2008; 52:167-74. 12. Frenkel S, Hendler K, Siegal T, et al. Intravitreal methotrexate for treating vitreoretinal lymphoma: 10 years of experience. Br J Oph- thalmol 2008;92:383-8. 13. Behin A, Hoang-Xuan K, Carpentier AF, Delattre JY. Primary brain tumours in adults. Lancet 2003;361:323-31. 14. Rothova A, Ooijman F, Kerkhoff F, et al. Uveitis masquerade syn- dromes. Ophthalmology 2001;108:386-99. 15. Ursea R, Heinemann MH, Silverman RH, et al. Ophthalmic, ult- rasonographic findings in primary central nervous system lym- phoma with ocular involvement. Retina 1997;17:118-23. 16. Corriveau C, Easterbrook M, Payne D. Lymphoma simulating uveitis (masquerade syndrome). Can J Ophthalmol 1986;21:144-9. 17. Whitcup SM, de Smet MD, Rubin BI, et al. Intraocular lymphoma. Clinical and histopathologic diagnosis. Ophthalmology 1993;100: 1399-406. 18. Wang JK, Yang CM, Lin CP, et al. An Asian patient with intrao- cular lymphoma treated by intravitreal methotrexate. Jpn J Oph- thalmol 2006;50:474-8. 19. Velez G, Yuan P, Sung C, et al. Pharmacokinetics and toxicity of intravitreal chemotherapy for primary intraocular lymphoma. Arch Ophthalmol 2001;119:1518-24.