Longitudinal Analysis of Ocular Manifestation and Interleukin During Intravitreal Treatment of Vitreoretinal Lymphoma With Methotrexate

• Published in: American journal of ophthalmology 2023-07, Vol.251, p.189-196
• Main Authors: Gu, Junxiang, Jiang, Tingting, Liu, Shixue, Chen, Xiuju, Wang, Zhujian, Zhang, Peijun, Wang, Ling, Jiang, Rui, Huang, Xin, Xu, Gezhi, Chang, Qing
• Format: Article
• Language: English
• Subjects: Eye Diseases - drug therapy; Eye Neoplasms - diagnosis; Eye Neoplasms - drug therapy; Humans; Interleukin-10 - therapeutic use; Intravitreal Injections; Lymphoma - diagnosis; Lymphoma - drug therapy; Lymphoma - pathology; Methotrexate - therapeutic use; Neoplasm Recurrence, Local - pathology; Retinal Neoplasms - diagnosis; Retinal Neoplasms - drug therapy; Retinal Neoplasms - pathology; Retrospective Studies; Vitreous Body - pathology
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2023.03.010

To explore the trend of ocular manifestations and interleukin (IL) during the treatment of vitreoretinal lymphoma (VRL) and to evaluate the potential effects of different intravitreal administration schedules on the therapeutic response. Interventional comparative nonrandomized clinical study. Patients diagnosed with VRL between January 2011 and January 2022 were included. Intravitreal methotrexate (MTX) injections consisting of induction, consolidation, and maintenance were scheduled. At baseline and each visit, ocular manifestations and IL in aqueous humor were recorded. Effects of the variations (eg, frequency and number) in the injection schedule on the therapeutic response were analyzed. Fifty-eight eyes of 33 patients were treated with intravitreal MTX chemotherapy. A mean ± standard deviation of 9 ± 3 injections were given; 52 eyes achieved complete remission (CR). IL-10, keratic precipitates, and subretinal lesions correlated well with the course of treatment (all P < .001). Initial injection given twice weekly was correlated with a higher rate of CR (36/36) than given once weekly or less frequently (16/22; P = .011). Ocular progression occurred in 13 eyes of 8 patients. The completion of schedule was correlated with PFS (induction + consolidation + maintenance: 547 [335-874] days; induction + consolidation: 355 [322-831] days; induction only: 147 [116-187.5] days; P < .001). IL-10 >50 pg/mL was a feasible threshold for the detection of ocular relapse (sensitivity 100.0%, specificity 95.1%). Keratic precipitates, subretinal lesions, and IL-10 could serve as indicators for therapeutic response. Intensive initial administration and adequate injection numbers would help to improve the response and prognosis. IL-10 >50 pg/mL could help detect ocular relapse.