# Safety and Efficacy of Intracameral Methotrexate and Targeted Radiotherapy for Subconjunctival Ocular Granulocytic Sarcoma: A Case Report

## TL;DR

A 28-year-old leukemia survivor was successfully treated for a rare eye tumor using targeted radiotherapy and methotrexate injections without vision loss.

## Contribution

This case report presents a novel treatment approach for ocular granulocytic sarcoma using combined targeted radiotherapy and intracameral methotrexate.

## Key findings

- Targeted radiotherapy and methotrexate injections achieved complete remission of the ocular granulocytic sarcoma.
- The treatment did not affect endothelial cell count or corneal morphology.
- No systemic or central nervous system leukemia recurrence was observed.

## Abstract

A 28-year-old male patient with a history of acute myeloid leukemia, who was in complete remission for 18 months after allogeneic peripheral blood stem cell transplantation (PBSCT), developed a salmon-pink nodular lesion of the upper bulbar conjunctiva with conjunctival vascular engorgement of the right eye, accompanied by severe anterior uveitis and hypopyon. Ocular granulocytic sarcoma (OGS) was diagnosed based on immunohistochemistry analysis of the tissue sample and flow cytometry analysis of the aqueous humour, representing a local recurrence of acute myeloid leukemia. Systemic and central nervous system infiltration was excluded. Targeted radiotherapy of the right eye (24 Gy/12 cycles) and a series of 12 intracameral injections of methotrexate (400 μg/0.1 ml) were implemented with no impact on the endothelial cell count or corneal morphology. Complete macroscopic and cytometric remission of the lesion was achieved without leaving any permanent visual defects.