Changes in choroidal vascular structure from vitreoretinal lymphoma and the intraocular cytokine level associated with clinical resolution after intravitreal methotrexate treatment.

Rae-Young Kim,Young-Geun Park,Young-Hoon Park,Mirinae Kim,Seok-Goo Cho,Jae Hyun Park,Demetrios G Vavvas

doi:10.1371/journal.pone.0260469

Rae-Young Kim, Young-Geun Park + Show 5 more

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https://doi.org/10.1371/journal.pone.0260469

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Abstract

PurposeTo evaluate changes in choroidal vascular structure and aqueous cytokine levels in eyes with vitreoretinal lymphoma (VRL) after intravitreal methotrexate (MTX) treatment.MethodsIn this retrospective study, VRL patients who visited our hospital between October 2018 and July 2020 were reviewed. Aqueous samples were obtained before treatment and at clinical resolution after intravitreal MTX therapy. Interleukin (IL)-6 and IL-10 levels and the IL-10-to-IL-6 ratio were evaluated. Swept-source optical coherence tomographic images were obtained along with the aqueous samples. Subfoveal choroidal thickness (SFCT), total vascular area of the choroid (TCA), stromal area (SA), luminal area (LA), and choroidal vascularity index (CVI) were assessed.ResultsTwelve patients were enrolled (female:male—5:7). The mean age (± standard deviation) at diagnosis was 60.9±8.5 years. In the 16 eyes diagnosed with VRL, values of SFCT, TCA, LA, and SA significantly decreased after treatment (all p-values <0.05). Additionally, the aqueous cytokine IL-10 level and IL-10-to-IL-6 ratio were significantly decreased (p = 0.001 and p = 0.003, respectively). The choroidal structure in the non-treated fellow eyes did not show any significant difference. There were no further changes in SFCT, TCA, LA, or CVI that occurred during maintenance therapy. For clinical remission, the patients received 7.7±5.5 intravitreal MTX injections. The required number of injections for clinical remission was positively correlated with best-corrected visual acuity, IL-10, and IL-6 levels in the active phase (p = 0.035, p = 0.009, and p = 0.031, respectively).ConclusionEyes with active VRL exhibited choroidal thickening with increased vascular and stromal areas that decreased after remission following MTX treatment. Higher aqueous IL-10 and IL-6 levels and lower visual acuity in the active phase may indicate the number of injections required for remission; this should be considered in the treatment of patients with VRL.

Highlights

Vitreoretinal lymphoma (VRL) is a rare subtype of central nervous system lymphoma [1, 2]
In the 16 eyes diagnosed with VRL, values of Subfoveal choroidal thickness (SFCT), total choroidal area (TCA), luminal area (LA), and stromal area (SA) significantly decreased after treatment
There were no further changes in SFCT, TCA, LA, or choroidal vascularity index (CVI) that occurred during maintenance therapy

Summary

Introduction

Vitreoretinal lymphoma (VRL) is a rare subtype of central nervous system lymphoma [1, 2]. The most common histopathologic type of VRL is diffuse large B-cell lymphoma (DLBCL). It is the most common subtype of non-Hodgkin’s lymphoma [3]. 65–90% of patients with primary VRL (PVRL) develop accompanying central nervous system (CNS) lymphomas over time, while over 15% of primary CNS lymphoma patients develop accompanying intraocular lymphoma [1, 4]. In one study of 47 patients with PVRL, the five-year survival rate was 41.4%, and the median overall survival was 38 months, which was poor compared to DLBCL that occurs outside the central nervous system [5, 6]. A multidisciplinary approach is required to increase the diagnostic rate [3]

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