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Casey Anthony, Clay Bavinger, Jessica Shantha, Alfredo Voloschin, Ghazala O'Keefe, Hans E Grossniklaus, Steven Yeh; Clinical Outcomes Following Intravitreal Methotrexate Therapy for Vitreoretinal Lymphoma. Invest. Ophthalmol. Vis. Sci. 2021;62(8):3306.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the clinical outcomes of intravitreal methotrexate (MTX) therapy for the treatment of vitreoretinal lymphoma (VRL)
Single-center retrospective case series of patients with a diagnosis of VRL and treated with intravitreal MTX at Emory University. Patient records were reviewed for demographic information, ocular exam findings, disease course, and treatment regimens including number of MTX injections. Clinical outcomes recorded included final visual acuity (VA), time to partial (PR) or complete response (CR), disease-free survival, time to relapse, number of relapses, and any non-ocular CNS progression.
Ten eyes of 7 patients (4 male, 6 female) were reviewed. The mean age was 70±years (range, 56-85). Five patients had a diagnosis of primary CNS lymphoma with a history of systemic chemotherapy. Three eyes (30%) exhibited vitreous involvement, four (40%) had subretinal lesions, and three (30%) presented with both. Mean initial logMAR VA was 0.38±0.52 (Snellen visual equivalent 20/50), while mean final logMAR VA was 0.34±0.27 (20/40) with a mean follow-up time of 26 months (range, 3-49 months).Patients received an average of 6 intravitreal MTX injections (range, 1-10) over the course of treatment. Two patients were receiving systemic chemotherapy at the time of injection. Mean time to either PR or CR was 57±37 days, and 6 eyes (60%) exhibited regression with no relapse after local treatment. For the 4 eyes that relapsed, time to first relapse was 193±155 days, and one eye experienced a second relapse. VA remained stable overall between initial treatment and 1, 3, 6, and 12-month follow-up (P>0.05 for paired comparisons); however, the largest VA improvement occurred at 3-months, with an average ~2-line improvement to 20/30. One patient with PVRL developed non-ocular CNS lymphoma.
Intravitreal MTX was well-tolerated and led to disease response in the majority of patients at approximately 2 months after initiation of treatment of intraocular lymphoma. Further studies on the efficacy of intravitreal treatment alone versus combined systemic and intravitreal treatment are warranted.
This is a 2021 ARVO Annual Meeting abstract.
(a) Subretinal/subRPE lymphoma diagnosed as intraocular lymphoma on fundus photography. (b) Regression of lesion one month after MTX injection. (c) OCT shows subRPE lesion. (d) Mild outer retinal irregularities following treatment.
Kaplain Meier curve of recurrence-free survival
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