Department of Ophthalmology, Fudan University Eye and ENT Hospital, Fudan University, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University Eye and ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
Shanghai Medical College, Fudan University, Shanghai, China.
Ophthalmol Retina. 2024 Apr;8(4):317-324. doi: 10.1016/j.oret.2023.10.021. Epub 2023 Nov 2.
To investigate the clinical features, risk factors, and prognosis of the intraocular recurrence in primary vitreoretinal lymphoma (PVRL).
Retrospective case-control study.
Ninety-seven eyes of 51 patients diagnosed with PVRL between December 2011 and January 2021 were enrolled in this study. Fourteen patients among them had experienced intraocular recurrence.
Data on demographic and ophthalmic characteristics, results of diagnostic tests, treatments, and prognosis of intraocular recurrence and nonrecurrence for PVRL patients were collected and compared. Multivariate logistic regression was used to identify independent risk factors. Receiver operating characteristic curves were used to determine the cutoff values.
Clinical features and risk factors.
Fourteen (19 eyes) of 51 PVRL patients had intraocular recurrences, resulting in a recurrence rate of 27.5% over a mean follow-up period of 42.5 months. No difference was observed in central nervous system lymphoma (CNSL) relapse rate (54.3% vs. 64.3%, P = 0.52) or median time to CNSL (36.5 months; 95% confidence interval [CI], 24.6-48.3 vs. 37.3 months; 95% CI, 24.8-49.8; P = 0.78) between intraocular nonrecurrence and intraocular recurrence groups. Furthermore, there were no statistically significant differences in the survival outcomes, such as mortality (28.6% vs. 29.7%, P = 1.00) and median overall survival (70.8 months; 95% CI, 54.0-87.7 vs. 59.2 months; 95% CI, 44.8-73.6; P = 0.30), between these 2 groups. Younger onset age (odds ratio [OR] 0.90; 95% CI, 0.84-0.98; P = 0.010), isolated PVRL (OR, 35.3; 95% CI, 2.08-600.0; P = 0.014), and no history of intravitreal chemotherapy (OR, 7.72; 95% CI, 1.37-43.6; P = 0.021) were identified as independent risk factors for intraocular recurrences. Of the patients with intraocular recurrence, 23.6% were asymptomatic and were diagnosed during routine follow-up. The rate of interleukin-10 (IL-10)/interleukin-6 > 1 was significantly lower than that at diagnosis (43.8% vs. 92.3%, P = 0.008). However, the rate of IL-10 ≥ 50 pg/mL was high (81.3%) and not significantly different from that at diagnosis (92.3%, P = 0.61).
This study did not identify an impact of intraocular recurrence on CNS manifestations or survival outcomes in patients with PVRL. Younger patients have a higher risk of intraocular recurrence, and combined systemic and intravitreal chemotherapy may reduce intraocular recurrence. Regular ophthalmic follow-up and IL-10 testing are recommended to detect intraocular recurrence.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
探讨原发性玻璃体视网膜淋巴瘤（PVRL）眼内复发的临床特征、危险因素和预后。
回顾性病例对照研究。
纳入 2011 年 12 月至 2021 年 1 月期间诊断为 PVRL 的 51 例患者的 97 只眼。其中 14 例患者经历了眼内复发。
收集并比较 PVRL 患者的人口统计学和眼科特征、诊断试验结果、治疗和眼内复发及非复发的预后数据。采用多因素逻辑回归分析确定独立的危险因素。采用受试者工作特征曲线确定截断值。
临床特征和危险因素。
51 例 PVRL 患者中有 19 只眼（19 只眼）发生眼内复发，平均随访 42.5 个月后复发率为 27.5%。眼内无复发组和眼内复发组中枢神经系统淋巴瘤（CNSL）复发率（54.3% vs. 64.3%，P=0.52）或中位 CNSL 时间（36.5 个月；95%置信区间，24.6-48.3 与 37.3 个月；95%置信区间，24.8-49.8；P=0.78）无差异。此外，两组在生存率方面，如死亡率（28.6% vs. 29.7%，P=1.00）和中位总生存期（70.8 个月；95%置信区间，54.0-87.7 与 59.2 个月；95%置信区间，44.8-73.6；P=0.30）方面均无统计学差异。较年轻的发病年龄（比值比[OR]0.90；95%置信区间，0.84-0.98；P=0.010）、孤立性 PVRL（OR，35.3；95%置信区间，2.08-600.0；P=0.014）和无眼内化疗史（OR，7.72；95%置信区间，1.37-43.6；P=0.021）是眼内复发的独立危险因素。在眼内复发的患者中，23.6%的患者无症状，在常规随访中诊断。白细胞介素-10（IL-10）/白细胞介素-6（IL-6）>1 的比例明显低于初诊时（43.8% vs. 92.3%，P=0.008）。然而，IL-10≥50pg/mL 的比例较高（81.3%），与初诊时无显著差异（92.3%，P=0.61）。
本研究未发现 PVRL 患者眼内复发对 CNS 表现或生存结果有影响。年轻患者眼内复发风险较高，联合全身和眼内化疗可能会降低眼内复发的风险。建议定期进行眼科随访和 IL-10 检测，以发现眼内复发。
本文末尾的脚注和披露中可能存在着专有或商业性质的披露。
