Medical Research Foundation, Shri Bhagwan Mahavir Vitreo-Retinal Services, Sankara Nethralaya, 18 College Road, Chennai, 600006, Tamilnadu, India.
Int Ophthalmol. 2021 Aug;41(8):2711-2722. doi: 10.1007/s10792-021-01828-8. Epub 2021 Apr 8.
To characterize the imaging features in eyes with vitreoretinal lymphoma (VRL) using ultra-widefield fundus photography (UWF-FP), swept-source optical coherence tomography (SSOCT) and fundus autofluorescence (FAF) that are correlated to ongoing treatment with intravitreal Rituximab(IVR).
Retrospective observational imaging-based study of 15 treatment-naive eyes with VRL treated with IVR. All patients with primary VRL underwent vitreous biopsy using 23/25G microincision vitrectomy system for confirmation of diagnosis. All eyes received monthly IVR (1 mg/0.1 mL) injections till disease remission. Baseline clinical characteristics, treatment details, outcomes, and sequential imaging features on UWF-FP, FAF, and SSOCT were analyzed.
Baseline features and changes in UWF-FP, FAF patterns, and SSOCT features in response to treatment RESULTS: Clinically, patients presented with sub-RPE deposits (n = 15), superficial retinal hemorrhages (n = 2), 'giant' RPE (retinal pigment epithelium) holes (n = 2), and anterior segment reaction (n = 1). Eyes were treated with mean 5.7 IVR injections (median: 5; range 1-13) over a mean 7.2 ± 4.9 months. During the course of treatment, two eyes developed superficial retinal hemorrhages with spontaneous resolution, 2 eyes developed CME, and 4 eyes developed characteristic 'leopard skin' pigmentation. Hyper-autofluorescence corresponding to areas of active lesions decreased with each treatment cycle and was finally replaced by hypo-autofluorescence. Serial OCTs showed regression of sub-RPE/subretinal deposits (n = 15), ellipsoid zone disruption (n = 9), and its resolution with treatment (n = 3), epiretinal membrane (ERM; n = 6), choroidal hyperreflective foci (HRF; n = 4), disorganization of retinal inner layers (DRIL; n = 3), RPE-rip (n = 2), cystoid macular edema (CME; n = 2), and hyperreflective lesions in the choroid (n = 1). Complete resolution was observed in all eyes with extensive hypo-AF. The central foveal thickness decreased from 237 ± 113 μ to 182 ± 114 μ (p = 0.1) and subfoveal choroidal thickness decreased from 258 ± 66 μ to 220 ± 64 μ (p = 0.12) at final follow-up. The mean baseline BCVA was logMAR 0.9 ± 0.9 that deteriorated to mean logMAR 1 ± 1 final visit (p = 0.7). The mean recurrence-free follow-up was 5.9 ± 5.1 months CONCLUSION: Multimodal imaging provides novel insights into features of VRL, a better understanding of regression patterns, and prognostication of outcomes when treated with intravitreal rituximab. Larger, multicentric studies with longer follow-up will help unravel imaging biomarkers to understand these aspects better.
使用超广角眼底摄影（UWF-FP）、扫频源光学相干断层扫描（SSOCT）和眼底自发荧光（FAF）来描述玻璃体视网膜淋巴瘤（VRL）眼中的影像学特征，这些特征与玻璃体内利妥昔单抗（IVR）治疗有关。
对 15 例经 IVR 治疗的未经治疗的 VRL 患者进行回顾性观察性成像研究。所有原发性 VRL 患者均采用 23/25G 微创玻璃体切除术系统进行玻璃体活检以确认诊断。所有患者均接受每月一次的 IVR（1mg/0.1mL）注射，直至疾病缓解。分析了基线临床特征、治疗细节、结果以及 UWF-FP、FAF 和 SSOCT 上的连续影像学特征。
临床上，患者表现为视网膜下沉积物（n=15）、浅层视网膜出血（n=2）、“巨大”RPE（视网膜色素上皮）孔（n=2）和前节反应（n=1）。这些患者平均接受了 5.7 次 IVR 注射（中位数：5；范围 1-13），平均治疗时间为 7.2±4.9 个月。在治疗过程中，有 2 只眼出现了自发性消退的浅层视网膜出血，2 只眼出现了 CME，4 只眼出现了特征性的“豹纹”样色素沉着。与活跃病变相对应的高自发荧光区域随着每个治疗周期的进行而减少，最终被低自发荧光取代。连续的 OCT 显示，视网膜下/视网膜沉积物（n=15）、椭圆体带中断（n=9）及其与治疗相关的缓解（n=3）、视网膜内界膜（ERM；n=6）、脉络膜高反射性病灶（HRF；n=4）、视网膜内层紊乱（DRIL；n=3）、RPE 撕裂（n=2）、黄斑囊样水肿（CME；n=2）和脉络膜高反射性病变（n=1）均有所消退。所有接受广泛低自发荧光治疗的患者均完全缓解。中央视网膜厚度从 237±113μm 下降到 182±114μm（p=0.1），中心凹下脉络膜厚度从 258±66μm 下降到 220±64μm（p=0.12），在最后一次随访时。基线时平均 BCVA 为 logMAR 0.9±0.9，最终随访时恶化至 logMAR 1±1（p=0.7）。平均无复发随访时间为 5.9±5.1 个月。
多模态成像为 VRL 的特征提供了新的见解，更好地理解了回归模式，并对玻璃体内利妥昔单抗治疗的预后进行了预测。更大规模、多中心、随访时间更长的研究将有助于揭示成像生物标志物，以更好地了解这些方面。
