Ophthalmol Retina. 2024 Jan;8(1):72-80. doi: 10.1016/j.oret.2023.08.012. Epub 2023 Aug 28.
Vitreoretinal lymphoma is a malignancy with high mortality. Incidence is rare, and there is a lack of medical evidence to direct management. This work describes presentation, diagnostic testing, and first treatment approaches in a recently diagnosed and treated patient cohort.
Clinical registry-based observational study.
Forty-eight women and 32 men (age range, 32-91 years; median age, 64 years) diagnosed with vitreoretinal lymphoma.
An international network of ophthalmologists reported clinical features and management of patients presenting with vitreoretinal lymphoma between January 1, 2020 and December 31, 2022 via an electronic platform.
Visual acuity at presentation (logarithm of the minimum angle of resolution [logMAR]); basis for diagnosis; first treatment.
Vitreoretinal lymphoma was bilateral at presentation in 65% of patients (n = 52) and an initial site of lymphoma in 78% (n = 62). Of 127 eyes with lymphoma at presentation, vitreous was involved in 89% (n = 113) and was the only involved eye tissue in 40% (n = 51), and retina was involved in 46% (n = 59) and was the only involved eye tissue in 9% (n = 11). Median logMAR visual acuity of the worse-seeing eye was 0.50. The lymphoma was diagnosed from ocular specimens in 80% of patients (64/80), usually vitreous (57/64 patients [89%]), and on other clinical information in 20% of patients (16/80). Cellular studies were performed on ocular specimens from 59 of 64 patients (92%), most often cytology. Tumor gene analysis was used in 21 of 64 patients (33%), and cytokine assays were used in 13 of 64 patients (20%). For 76 patients (95%), treatment was initiated within 6 months of diagnosis and included ocular (38/76 [48%]), extraocular (17/76 [21%]), and ocular plus extraocular (21/76 [26%]) approaches. Intravitreal methotrexate was the most common ocular treatment (83/87 eyes [95%]).
Using data collected from 80 patients diagnosed with vitreoretinal lymphoma since 2020, we show that visual impairment is common, and that management often involves diagnosis by cellular tests and treatment with intravitreal chemotherapy.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
脉络膜视网膜淋巴瘤是一种死亡率很高的恶性肿瘤。发病率较低，缺乏医学证据指导治疗。本研究描述了最近确诊并接受治疗的患者队列的临床表现、诊断检测和首次治疗方法。
基于临床注册的观察性研究。
48 名女性和 32 名男性（年龄 32-91 岁；中位年龄 64 岁），诊断为脉络膜视网膜淋巴瘤。
国际眼科医生网络通过电子平台报告了 2020 年 1 月 1 日至 2022 年 12 月 31 日期间出现脉络膜视网膜淋巴瘤的患者的临床特征和治疗方法。
就诊时的视力（最小分辨角对数[logMAR]）；诊断依据；首次治疗。
65%（n=52）的患者就诊时为双眼受累，78%（n=62）的患者为淋巴瘤的首发部位。就诊时 127 只眼受累，玻璃体受累 89%（n=113），其中 40%（n=51）为唯一受累眼组织，视网膜受累 46%（n=59），其中 9%（n=11）为唯一受累眼组织。视力最差眼的中位 logMAR 视力为 0.50。80%的患者（64/80）通过眼部标本诊断为淋巴瘤，通常为玻璃体（57/64 例[89%]），20%的患者（16/80）通过其他临床信息诊断。对 64 例患者中的 59 例（92%）的眼部标本进行了细胞学检查，最常见的是细胞学检查。对 21 例患者（33%）进行了肿瘤基因分析，对 13 例患者（20%）进行了细胞因子检测。对于 76 例患者（95%），在诊断后 6 个月内开始治疗，包括眼部（38/76 [48%]）、眼外（17/76 [21%]）和眼部加眼外（21/76 [26%]）方法。最常见的眼部治疗是玻璃体内注射甲氨蝶呤（83/87 眼[95%]）。
使用自 2020 年以来 80 例脉络膜视网膜淋巴瘤患者的数据，我们发现视力损害很常见，治疗通常涉及细胞检测诊断和玻璃体内化疗。
