Role of intravitreal methotrexate in the management of primary central nervous system lymphoma with ocular involvement
Role of intravitreal methotrexate in the management of primary central nervous system lymphoma with ocular involvement
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DOI：
10.1016/s0161-6420(02)01125-9
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发表时间：
2002-09-01
期刊：
影响因子：
13.7
通讯作者：
Pe'er, J
中科院分区：
文献类型：
--
作者：
Smith, JR;Rosenbaum, JT;Pe'er, J
目的：评价玻璃体内注射甲氨蝶呤治疗原发性中枢神经系统淋巴瘤（PCNSL）累及眼部的安全性和有效性。设计：回顾性非比较性干预病例系列。参与者：16例人类免疫缺陷病毒阴性白色患者（5名男性和11名女性，年龄30-76岁），患有眼内B细胞淋巴瘤，在俄勒冈州健康中心接受玻璃体内甲氨蝶呤治疗1995年8月至2000年9月期间，在国立科学大学或哈达萨大学医院接受治疗。玻璃体内注射甲氨蝶呤（400 μ g/0.1ml），并通过系列检查进行监测，包括测量视敏度，裂隙灯生物显微镜检查和散瞳眼底镜检查。主要观察指标：玻璃体内化疗的临床反应，临床缓解的注射次数，视力，研究期间的并发症，诊断后的生存时间和死亡原因。从甲氨蝶呤注射开始的随访时间为6至35个月（中位数，18.5个月）。在最多12次甲氨蝶呤注射后，26只眼（100%）的恶性细胞临床清除。第二次缓解诱导三名患者，谁是进一步的玻璃体内化疗后，他们的肿瘤复发的眼睛。治疗和随访期间发生的并发症包括白内障（73%/26只眼）、角膜上皮病变（58%/26只眼）、黄斑病变（42%/26只眼）、玻璃体积血（8%/26只眼）、视神经萎缩（4%/26只眼）和无菌性眼内炎（4%/26只眼）。没有病人有不可逆的视力丧失，可以肯定地归因于玻璃体内注射的methotrexate.Conclusions：玻璃体内化疗与methotrexate是有效的诱导PCNSL眼内肿瘤的临床缓解与可接受的发病率。进一步的研究表明，以确定这种方法是否延长预期寿命。
Purpose: To evaluate the safety and efficacy of intravitreal methotrexate in the management of primary central nervous system lymphoma (PCNSL) involving the eye.Design: Retrospective noncomparative interventional case series.Participants: Sixteen human immunodeficiency virus-negative white patients (5 males and 11 females, aged 30-76 years) with intraocular B cell lymphoma treated with intravitreal methotrexate at Oregon Health & Science University or Hadassah University Hospital between August 1995 and September 2000.Intervention: Patients were treated with intravitreal methotrexate (400 mug/0.1 ml) according to a standard induction-consolidation-maintenance regimen and monitored by serial examinations, including measurement of visual acuity, slit-lamp biomicroscopy, and dilated funduscopy.Main Outcome Measures: Clinical response to intravitreal chemotherapy, number of injections for clinical remission, visual acuity, complications during study period, length of survival from diagnosis, and cause of death.Results. Time of follow-up from commencement of the methotrexate injections was 6 to 35 months (median, 18.5 months). Twenty-six of 26 eyes (100%) were cleared clinically of malignant cells after a maximum of 12 methotrexate injections. A second remission was induced in three patients, who were treated with a further course of intravitreal chemotherapy after their tumor recurred within the eye. Complications that occurred during the period of treatment and follow-up included cataract (73% of 26 eyes), corneal epitheliopathy (58% of 26 eyes), maculopathy (42% of 26 eyes), vitreous hemorrhage (8% of 26 eyes), optic atrophy (4% of 26 eyes), and sterile endophthalmitis (4% of 26 eyes). No patient had irreversible loss of vision that could be definitely attributed to the intravitreal injection of methotrexate.Conclusions: Intravitreal chemotherapy with methotrexate is effective in inducing clinical remission of intraocular tumor in PCNSL with acceptable morbidity. Further study is indicated to determine whether this approach extends life expectancy.