Intravitreal methotrexate chemotherapy in the treatment of 14 patients with priamary vitreoretinal lymphoma_Chinese Journal of Ocular Fundus Diseases

Authors：

ChenXiuju ,  ChangQing , JiangRui , ZhouMin , HuangXin , ZhangYanqiong , XuGezhi , WangWenji

Department of Ophthalmology, Shanghai Eye & ENT Hospital of Fudan University, Shanghai 200031, China;

Corresponding author：

ChangQing, Email: qngchang@aliyun.com

Keywords：

Eye neoplasms/drug therapy; Lymphoma/drug therapy; Methotrexate/therapeutic use; Chemotherapy,cancer,regional perfusion; Intravitreal injections

DOI：

10.3760/cma.j.issn.1005-1015.2016.04.013

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Objective To evaluate the safety and efficacy of the intravitreal methotrexate treatment in patients with primary vitreoretinal lymphoma (PVRL). Methods Retrospective non-comparative interventional case series. Fourteen patients (26 eyes) with biopsy-proven PVRL were included in the study. All patients received examination of Snellen chart visual acuity, fundus color photography and optical coherence tomography (OCT). Among the 24 eyes with recordable visual acuity, 17 eyes has initial visual acuity≥0.1 (0.45±0.20) and 7 eyes with initial visual acuity ranged from light perception to hand movement. The vitreous opacities and (or) subretinal yellowish-white lesions and retinal pigment epitheliumuplift were observed in all eyes. All eyes were treated with intravitreal methotrexate (4000 μg/ml, 0.1 ml) injections according to a induction-consolidation-maintenance regimen. For 26 treated eyes, each received an average of (11.5±6.3) injections. Twenty eyes had finished theintraocular chemotherapy, while 6 eyes had not. Eight of 20 eyes were clinically confirmed free of tumor cells by diagnostic vitrectomy, 12 eyes were still with tumor cell involvement.The follow-up was ranged from 2 to 48 months, the mean time was 18 months. The examination of BCVA, fundus color photography and OCT were performed. No tumor cell was defined as clinical remission. Visual acuity was scored as improved or declined obviously (improved or declined 2 lines) or mild improved or declined (changed within 2 lines). Results Twenty eyes achieved clinical remission after (3.5±3.6) injections, 12 eyes of 20 eyes with tumor cell involvement before chemotherapy achieved clinical remission after (5.8±3.0) injections. The mean visual acuity of seventeen eyes with initial visual acuity 0.1 in induction phase and at the end of treatment were 0.36±0.23 and 0.56±0.20, respectively. Compared with before treatment, the visual acuity was mild declined in induction phase (t=1.541, P>0.05), but mild improved at the end of treatment (t=2.639, P<0.05). The visual acuity at the end of treatment in 7 eyes with initial visual acuity<0.1 was ranged from no light perception to 0.1. Of 14 patients, 2 patients have been fatal because of brain lesions progression at 42 and 48 months after diagnosis of primary central nervous system lymphoma. No ocular recurrence was noted during the follow-up in 20 eyes who finished intraocular chemotherapy. Conclusions PVRL patients can achieve clinical remission after (3.5±3.6) injections by intravitreal chemotherapy of methotrexate, and the visual acuity improved mildly. No ocular recurrence was found during follow-up.

Citation： ChenXiuju, ChangQing, JiangRui, ZhouMin, HuangXin, ZhangYanqiong, XuGezhi, WangWenji. Intravitreal methotrexate chemotherapy in the treatment of 14 patients with priamary vitreoretinal lymphoma. Chinese Journal of Ocular Fundus Diseases, 2016, 32(4): 399-403. doi: 10.3760/cma.j.issn.1005-1015.2016.04.013 Copy

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7.	Riemens A, Bromberg J, Touitou V, et al. Treatment strategies in primary vitreoretinal lymphoma:a 17-center European collaborative study[J]. JAMA Ophthalmol, 2015, 133(2):191-197. DOI:10.1001/jamaophthalmol.2014.4755.
8.	Smith JR, Rosenbaum JT, Wilson DJ, et al. Role of intravitreal methotrexate in the management of primary central nervous system lymphoma with ocular involvement[J]. Ophthalmology, 2002, 109(9):1709-1716.
9.	Velez G, Yuan P, Sung C, et al. Pharmacokinetics and toxicity of intravitreal chemotherapy for primary intraocular lymphoma[J]. Arch Ophthalmol, 2001, 119(10):1518-1524.
10.	Gorovoy I, Prechanond T, Abia M,et al.Toxic corneal epitheliopathy after intravitreal methotrexate and its treatment with oral folic acid[J].Cornea,2013,32(8):1171-1173. DOI:10.1097/ICO.0b013e3182910106.

1. Chan CC, Sen HN. Current concepts in diagnosing and managing primary vitreoretinal (intraocular) lymphoma[J]. Discov Med, 2013, 15(81):93-100.
2. Touitou V, Lehoang P, Bodaghi B. Primary CNS lymphoma[J]. Curr Opin Ophthalmol, 2015, 26(6):526-533. DOI:10.1097/ICU.0000000000000213.
3. Chan CC, Rubenstein JL, Coupland SE, et al. Primary vitreoretinal lymphoma:a report from an international primary central nervous system lymphoma collaborative group symposium[J]. Oncologist, 2011, 16(11):1589-1599.DOI:10.1634/theoncologist.2011-0210.
4. Grimm SA, Pulido JS, Jahnke K, et al. Primary intraocular lymphoma:an international primary central nervous system lymphoma collaborative group report[J]. Ann Oncol, 2007, 18(11):1851-1855. DOI:10.1093/annonc/mdm340.
5. Fishbume BC, Wilson DJ, Rosenbaum JT, et al. Intravitreal methotrexate as an adjunctive treatment of intraocular lymphoma[J]. Arch Ophthalmol, 1997, 115(9):1152-1156.
6. Frenkel S, Hendler K, Siegal T, et al. Intravitreal methotrexate for treating vitreoretinal lymphoma:10 years of experience[J]. Br J Ophthalmol, 2008, 92(3):383-388. DOI:10.1136/bjo.2007.127928.
7. Riemens A, Bromberg J, Touitou V, et al. Treatment strategies in primary vitreoretinal lymphoma:a 17-center European collaborative study[J]. JAMA Ophthalmol, 2015, 133(2):191-197. DOI:10.1001/jamaophthalmol.2014.4755.
8. Smith JR, Rosenbaum JT, Wilson DJ, et al. Role of intravitreal methotrexate in the management of primary central nervous system lymphoma with ocular involvement[J]. Ophthalmology, 2002, 109(9):1709-1716.
9. Velez G, Yuan P, Sung C, et al. Pharmacokinetics and toxicity of intravitreal chemotherapy for primary intraocular lymphoma[J]. Arch Ophthalmol, 2001, 119(10):1518-1524.
10. Gorovoy I, Prechanond T, Abia M,et al.Toxic corneal epitheliopathy after intravitreal methotrexate and its treatment with oral folic acid[J].Cornea,2013,32(8):1171-1173. DOI:10.1097/ICO.0b013e3182910106.

Chinese Journal of Ocular Fundus Diseases

Intravitreal methotrexate chemotherapy in the treatment of 14 patients with priamary vitreoretinal lymphoma

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