de Smet M D, Vancs V S, Kohler D, Solomon D, Chan C C
Clinical Immunology Section, Laboratory of Immunology, National Eye Institute, Netherlands.
Br J Ophthalmol. 1999 Apr;83(4):448-51. doi: 10.1136/bjo.83.4.448.
To develop and assess a protocol for the treatment of intraocular lymphoma by intravitreal injection of methotrexate and thiotepa.
A patient with intraocular non-Hodgkin's lymphoma which recurred after radiotherapy and repeated systemic chemotherapeutic regimens underwent repeated intravitreal injections of methotrexate and thiotepa. The patient was closely monitored by cytology, anterior chamber flare measurements, IL-10 and IL-6 levels. Methotrexate drug clearance studies were performed on vitreous samples taken before each injection.
Complete tumour clearance was achieved by the third week of therapy. IL-10 and IL-6 levels quickly dropped to barely detectable levels as the tumour was cleared from the eye. Flare measurements decreased from 500 to 15 photons/s over the same time. A plot of the methotrexate levels over time revealed a first order kinetic rate of elimination with an effective tumoricidal intravitreal dose persisting for 5 days after injection.
Intravitreal chemotherapy for the treatment of recurrent intraocular lymphoma appears effective in prolonging local remission of ocular disease even in the presence of an aggressively growing tumour. A single intravitreal injection of methotrexate can lead to a prolonged tumoricidal concentration lasting for a longer period than that achieved by systemic administration.
制定并评估一种通过玻璃体内注射甲氨蝶呤和噻替派治疗眼内淋巴瘤的方案。
一名眼内非霍奇金淋巴瘤患者在放疗及重复全身化疗方案后复发，接受了多次玻璃体内注射甲氨蝶呤和噻替派。通过细胞学检查、前房闪辉测量、白细胞介素-10和白细胞介素-6水平对患者进行密切监测。在每次注射前采集的玻璃体样本上进行甲氨蝶呤药物清除研究。
治疗第三周实现了肿瘤完全清除。随着肿瘤从眼中清除，白细胞介素-10和白细胞介素-6水平迅速降至几乎检测不到的水平。在同一时期，闪辉测量值从500降至15光子/秒。甲氨蝶呤水平随时间变化的曲线显示出一级动力学消除率，玻璃体内有效杀肿瘤剂量在注射后持续5天。
玻璃体内化疗治疗复发性眼内淋巴瘤似乎有效地延长了眼部疾病的局部缓解期，即使存在生长迅速的肿瘤。单次玻璃体内注射甲氨蝶呤可导致延长的杀肿瘤浓度，持续时间比全身给药更长。
