Clinical outcomes following intravitreal methotrexate for primary vitreoretinal lymphoma

Abstract Purpose To describe the visual acuity and anatomic outcomes of intravitreal methotrexate (MTX) for the treatment of primary vitreoretinal lymphoma (PVRL). Methods Single-center retrospective case series of patients with a diagnosis of PVRL treated with intravitreal MTX. Patient records were...

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Autores principales:	Casey L. Anthony, J. Clay Bavinger, Jessica G. Shantha, Ghazala D. O’Keefe, William A. Pearce, Alfredo Voloschin, Hans E. Grossniklaus, Steven Yeh
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Primary vitreoretinal lymphoma Primary intraocular lymphoma Primary central nervous system lymphoma Methotrexate Intravitreal PCNSL Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/cb905c3d1d9e4f9dbac2c843e2205625
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spelling	oai:doaj.org-article:cb905c3d1d9e4f9dbac2c843e22056252021-12-05T12:19:10ZClinical outcomes following intravitreal methotrexate for primary vitreoretinal lymphoma10.1186/s40942-021-00346-02056-9920https://doaj.org/article/cb905c3d1d9e4f9dbac2c843e22056252021-12-01T00:00:00Zhttps://doi.org/10.1186/s40942-021-00346-0https://doaj.org/toc/2056-9920Abstract Purpose To describe the visual acuity and anatomic outcomes of intravitreal methotrexate (MTX) for the treatment of primary vitreoretinal lymphoma (PVRL). Methods Single-center retrospective case series of patients with a diagnosis of PVRL treated with intravitreal MTX. Patient records were reviewed for demographic information, ocular exam findings, and treatment regimens including number of MTX injections. Clinical outcomes recorded included visual acuity (VA), time to partial (PR) or complete response (CR), disease-free survival, time to relapse, and any CNS progression. Results Ten eyes of 7 patients (4 male, 6 female) were reviewed. The mean age ± standard deviation (SD) was 70 ± 12 years. Five patients had prior or concomitant diagnosis of primary CNS lymphoma with a history of systemic chemotherapy including MTX. Three eyes (30%) exhibited isolated vitreous involvement, four (40%) had subretinal lesions, and three (30%) presented with both vitreous and subretinal disease. Mean initial logMAR VA was 0.38 ± 0.52 (Snellen visual equivalent 20/50), while mean final logMAR VA ± SD was 0.34 ± 0.27 (Snellen visual equivalent 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 received concomitant systemic chemotherapy. Mean time to either PR or CR was 57 days, and 6 eyes (60%) exhibited regression with no relapse after local treatment. For the 4 eyes that eventually relapsed, the mean time ± SD to first relapse was 193 days ± 155 days, and one eye experienced a second relapse. Two of 3 patients with subretinal disease showed complete regression with extended follow-up of 1 and 4 years following treatment with less than 3 doses of intravitreal MTX. One patient with PVRL developed CNS lymphoma during the study period. VA remained stable overall between the initial treatment visit, 3, 6, and 12-months (P > 0.05 for paired comparisons of VA over time). Conclusions Intravitreal methotrexate was well-tolerated and led to local 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.Casey L. AnthonyJ. Clay BavingerJessica G. ShanthaGhazala D. O’KeefeWilliam A. PearceAlfredo VoloschinHans E. GrossniklausSteven YehBMCarticlePrimary vitreoretinal lymphomaPrimary intraocular lymphomaPrimary central nervous system lymphomaMethotrexateIntravitrealPCNSLOphthalmologyRE1-994ENInternational Journal of Retina and Vitreous, Vol 7, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Primary vitreoretinal lymphoma Primary intraocular lymphoma Primary central nervous system lymphoma Methotrexate Intravitreal PCNSL Ophthalmology RE1-994
spellingShingle	Primary vitreoretinal lymphoma Primary intraocular lymphoma Primary central nervous system lymphoma Methotrexate Intravitreal PCNSL Ophthalmology RE1-994 Casey L. Anthony J. Clay Bavinger Jessica G. Shantha Ghazala D. O’Keefe William A. Pearce Alfredo Voloschin Hans E. Grossniklaus Steven Yeh Clinical outcomes following intravitreal methotrexate for primary vitreoretinal lymphoma
description	Abstract Purpose To describe the visual acuity and anatomic outcomes of intravitreal methotrexate (MTX) for the treatment of primary vitreoretinal lymphoma (PVRL). Methods Single-center retrospective case series of patients with a diagnosis of PVRL treated with intravitreal MTX. Patient records were reviewed for demographic information, ocular exam findings, and treatment regimens including number of MTX injections. Clinical outcomes recorded included visual acuity (VA), time to partial (PR) or complete response (CR), disease-free survival, time to relapse, and any CNS progression. Results Ten eyes of 7 patients (4 male, 6 female) were reviewed. The mean age ± standard deviation (SD) was 70 ± 12 years. Five patients had prior or concomitant diagnosis of primary CNS lymphoma with a history of systemic chemotherapy including MTX. Three eyes (30%) exhibited isolated vitreous involvement, four (40%) had subretinal lesions, and three (30%) presented with both vitreous and subretinal disease. Mean initial logMAR VA was 0.38 ± 0.52 (Snellen visual equivalent 20/50), while mean final logMAR VA ± SD was 0.34 ± 0.27 (Snellen visual equivalent 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 received concomitant systemic chemotherapy. Mean time to either PR or CR was 57 days, and 6 eyes (60%) exhibited regression with no relapse after local treatment. For the 4 eyes that eventually relapsed, the mean time ± SD to first relapse was 193 days ± 155 days, and one eye experienced a second relapse. Two of 3 patients with subretinal disease showed complete regression with extended follow-up of 1 and 4 years following treatment with less than 3 doses of intravitreal MTX. One patient with PVRL developed CNS lymphoma during the study period. VA remained stable overall between the initial treatment visit, 3, 6, and 12-months (P > 0.05 for paired comparisons of VA over time). Conclusions Intravitreal methotrexate was well-tolerated and led to local 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.
format	article
author	Casey L. Anthony J. Clay Bavinger Jessica G. Shantha Ghazala D. O’Keefe William A. Pearce Alfredo Voloschin Hans E. Grossniklaus Steven Yeh
author_facet	Casey L. Anthony J. Clay Bavinger Jessica G. Shantha Ghazala D. O’Keefe William A. Pearce Alfredo Voloschin Hans E. Grossniklaus Steven Yeh
author_sort	Casey L. Anthony
title	Clinical outcomes following intravitreal methotrexate for primary vitreoretinal lymphoma
title_short	Clinical outcomes following intravitreal methotrexate for primary vitreoretinal lymphoma
title_full	Clinical outcomes following intravitreal methotrexate for primary vitreoretinal lymphoma
title_fullStr	Clinical outcomes following intravitreal methotrexate for primary vitreoretinal lymphoma
title_full_unstemmed	Clinical outcomes following intravitreal methotrexate for primary vitreoretinal lymphoma
title_sort	clinical outcomes following intravitreal methotrexate for primary vitreoretinal lymphoma
publisher	BMC
publishDate	2021
url	https://doaj.org/article/cb905c3d1d9e4f9dbac2c843e2205625
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Clinical outcomes following intravitreal methotrexate for primary vitreoretinal lymphoma

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