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

Abstract

To explore the trend of ocular manifestations and interleukin (IL) during the treatment of vitreoretinal lymphoma (VRL), and to evaluate potential effects of different intravitreal administration schedules on the therapeutic response. Interventional comparative non-randomized clinical study. Patients diagnosed with VRL from January 2011 to January 2022 were included. Intravitreal methotrexate (MTX) injections consisting induction, consolidation and maintenance were scheduled. At baseline and each visit, ocular manifestations and interleukin in aqueous humor were recorded. Effects of the variations (e.g. 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 (±SD) of 9±3 injections were given; 52 eyes achieved complete remission (CR). IL-10, keratic precipitates and sub-retinal lesions correlated well with the course of treatment (all P <0.001). 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=0.011). 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<0.001). IL-10 over 50 pg/mL was a feasible threshold for the detection of ocular relapse (sensitivity 100.0%, specificity 95.1%). Keratic precipitates, sub-retinal lesions and IL-10 could serve as indicators for therapeutic response. Intensive initial administration and adequate injection number would help to improve the response and prognosis. IL-10 over 50 pg/mL could help to detect ocular relapse.