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Eyewash with balanced salt solution after intravitreal methotrexate injection in a case of vitreoretinal lymphoma: a simple but effective way to prevent ocular surface toxicity
  1. Bruttendu Moharana,
  2. Sucheta Parija,
  3. Shanmugasundaram Palanisamy and
  4. Priyadarshini Mishra
  1. Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
  1. Correspondence to Dr Bruttendu Moharana; drmoharana{at}


Intravitreal methotrexate injection (400 µg/0.1 mL) is the current mainstay for managing vitreoretinal lymphoma. Various complications associated with intravitreal methotrexate are cataract, keratopathy, maculopathy, sterile endophthalmitis, optic atrophy, vitreous haemorrhage, etc. The most common adverse effect of intravitreal methotrexate is keratopathy occurring in more than half of cases. The severity may range from diffuse punctate keratopathy to severe epitheliopathy leading to photophobia, pain, visual blurring, epiphora, etc. This may become a reason for reduced compliance with treatment. The management of these complications includes oral folic acid, topical folinic acid supplementations and reduced frequency or cessation of methotrexate intravitreal injections. Here, we report a simple method of eyewash in a large amount of balanced salt solution after the intravitreal injection procedure to reduce the severity of keratopathy, which helped the patient tolerate the treatment.

  • Ophthalmology
  • Eye
  • Intraocular Lymphoma

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  • Contributors The following authors were responsible for the drafting of the text: BM, sourcing and editing of clinical images. BM, SPalanisamy, PM and investigation results. BM and critical revision for important intellectual content: SParija. The following author gave final approval of the manuscript: BM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.