Longitudinal Analysis of Ocular Manifestation and Interleukin During Intravitreal Treatment of Vitreoretinal Lymphoma With Methotrexate
Longitudinal Analysis of Ocular Manifestation and Interleukin During Intravitreal Treatment of Vitreoretinal Lymphoma With Methotrexate
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DOI：
10.1016/j.ajo.2023.03.010
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发表时间：
2023-05-14
影响因子：
4.2
通讯作者：
Chang，Qing
中科院分区：
文献类型：
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作者：
Gu，Junxiang;Jiang，Tingting;Chang，Qing
目的探讨玻璃体视网膜淋巴瘤（VRL）治疗过程中眼部表现和白细胞介素（IL）的变化趋势，评估不同玻璃体腔给药方案对治疗反应的潜在影响。设计介入性比较非随机临床研究。方法纳入2011年1月至2022年1月诊断为VRL的患者。玻璃体内注射甲氨蝶呤（MTX），包括诱导、巩固和维持。在基线和每次就诊时，记录眼部表现和房水中的 IL。分析注射方案的变化（例如频率和次数）对治疗反应的影响。结果33 名患者的 58 只眼睛接受了玻璃体内 MTX 化疗。给出了 9 ± 3 次进样的平均值 ± 标准差； 52 只眼睛达到完全缓解 (CR)。 IL-10、角化沉淀物和视网膜下病变与治疗过程密切相关（所有 P< .001）。每周两次初始注射与每周一次或频率较低的注射 (16/22;P=.011) 相比，CR 率 (36/36) 更高。 8 名患者的 13 只眼睛发生了眼部进展。计划完成情况与 PFS 相关（诱导 + 巩固 + 维持：547 [335-874] 天；诱导 + 巩固：355 [322-831] 天；仅诱导：147 [116-187.5] 天；P< .001）。 IL-10>50 pg/mL是检测眼部复发的可行阈值（敏感性100.0%，特异性95.1%）。结论角质沉淀、视网膜下病变和IL-10可以作为治疗反应的指标。密集的初始给药和足够的注射次数将有助于改善反应和预后。 IL-10 >50 pg/mL 有助于检测眼部复发。
PurposeTo explore the trend of ocular manifestations and interleukin (IL) during the treatment of vitreoretinal lymphoma (VRL) and to evaluate the potential effects of different intravitreal administration schedules on the therapeutic response.DesignInterventional comparative nonrandomized clinical study.MethodsPatients diagnosed with VRL between January 2011 and January 2022 were included. Intravitreal methotrexate (MTX) injections consisting of induction, consolidation, and maintenance were scheduled. At baseline and each visit, ocular manifestations and IL in aqueous humor were recorded. Effects of the variations (eg, frequency and number) in the injection schedule on the therapeutic response were analyzed.ResultsFifty-eight eyes of 33 patients were treated with intravitreal MTX chemotherapy. A mean ± standard deviation of 9 ± 3 injections were given; 52 eyes achieved complete remission (CR). IL-10, keratic precipitates, and subretinal lesions correlated well with the course of treatment (allP< .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= .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< .001). IL-10 >50 pg/mL was a feasible threshold for the detection of ocular relapse (sensitivity 100.0%, specificity 95.1%).ConclusionKeratic precipitates, subretinal lesions, and IL-10 could serve as indicators for therapeutic response. Intensive initial administration and adequate injection numbers would help to improve the response and prognosis. IL-10 >50 pg/mL could help detect ocular relapse.