Abstract
BackgroundDeveloping objective and repeatable indicators to evaluate the efficacy of PVRL treatment is important. The quantification of vitreous cells is a traditional criterion; however slight changes are difficult to ascertain. Spectral domain optical coherence tomography (SD-OCT) is objective, repeatable, and easily explained. The purpose of this study is to provide a longitudinal observation of OCT in PVRL treated with intravitreal injections of methotrexate (MTX) and to evaluate the utility of OCT in monitoring responsiveness of PVRL to treatment.MethodsThe medical records of patients with biopsy-positive PVRL attending our hospital between January 2016 and September 2017 who received intravitreal injections of MTX were included in this study. Pre- and post-treatment OCT images were reviewed independently by two researchers.ResultsOf the 24 cases reviewed, 10 patients (18 eyes) were included. SD-OCT abnormalities at the initial visit included vitreous cells (18/18), OR (outer retina) fuzzy borders (12/18), PED (pigment epithelium detachments) (9/18), subretinal hyperreflective infiltration (3/18), intraretinal infiltration (8/18), and SRF (subretinal fluid) (4/18). Post induction treatment, SRF in cases with RD (retinal detachment) was absorbed, and subretinal fibrosis appeared. Other lesions were significantly reduced. Post consolidation treatment, OR fuzzy borders, PED and SRF disappeared in 2 eyes, intraretinal infiltration disappeared in 1 eye, and other abnormalities further improved. Additionally, retinal fibrosis was observed in 3 eyes. One month post maintenance treatment, all abnormalities observed at the first visit vanished. At the last visit, OCT showed subretinal fibrosis and in 3 eyes (16.7%), the disruption of outer retina in 9 eyes (50%) and thinning of the whole layer in 4 eyes (22.2%).ConclusionsOur observations reveal that characteristic OCT features in PVRL patients can reduce gradually and finally vanish with therapy. We propose that SD-OCT may be employed to monitor the responsiveness of PVRL to treatment, which may influence decision making in the management of this disease.
Highlights
Developing objective and repeatable indicators to evaluate the efficacy of Primary vitreoretinal lymphoma (PVRL) treatment is important
PVRL is associated with primary central nervous system lymphoma (PCNSL) in up to 80% of cases with poor prognosis [1]
We present a relatively large series of longitudinal Spectral domain optical coherence tomography (SD-Optical coherence tomography (OCT)) images from PVRL patients who were regularly treated with intravitreal injections of MTX
Summary
Developing objective and repeatable indicators to evaluate the efficacy of PVRL treatment is important. Developing objective, unified and repeatable indicators to evaluate the efficacy of PVRL treatment is important. PVRL exhibits responsiveness to intravitreal MTX in some patients; there is no set regimen, even in a given center [3]. The use of stem cell transplantation, ibrutinib or intravenous methotrexate for refractory or recurrent cases of PVRL has been proven to be partially effective in some clinical trials [5]. To arrive at scientifically valid guidelines for managing PVRL, it is necessary to develop objective and uniform indicators to compare the effects of different therapeutic regimens and to understand the effect of choosing different end points of treatment on the prognosis of PVRL
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