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Guneri Beser B, Demirci H. Acute Sterile Endophthalmitis Following Intravitreal Rituximab Injection in Primary Vitreoretinal Lymphoma: Case Series. Ocul Immunol Inflamm 2024; 32:863-868. [PMID: 36952513 DOI: 10.1080/09273948.2023.2190802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE OR PURPOSE To describe sterile endophthalmitis following intravitreal rituximab (Rituxan, Genentech) injection for treatment of vitreoretinal lymphoma (VRL). DESIGN Retrospective case series. SUBJECTS, PARTICIPANTS, AND/OR CONTROLS Medical records of biopsy-proven VRL patients who received intravitreal rituximab (RTX) between January 2011 and December 2021 in Kellogg Eye Center, University of Michigan were reviewed. 3 patients presented with sterile endophthalmitis after the second dose of intravitreal RTX were included.Methods, Intervention, or Testing: Intravitreal methotrexate (400µg/0.1ml) and rituximab (1mg/0.1ml) injections given a week apart, monthly.Main Outcome Measures: Clinical presentation and response to treatment including visual acuity, degree of inflammation and intraocular pressure . RESULTS All cases had bilateral disease and received the first dose of intravitreal RTX without any side effects. All cases developed bilateral corneal edema with Descemet's folds, mutton-fat keratic precipitates, anterior chamber and vitreous cells with hazy fundus view approximately within 1 week after the second RTX injection. Intraocular pressures were increased in Cases 2 and 3. Clinical findings improved to baseline with topical corticosteroid therapy within 1 month in all cases, and additional topical antiglaucomatous medication in Cases 2 and 3. Additionally, Case 1 received the third dose of RTX injection to the right eye 1 month after the second injection and repeating dense anterior chamber and vitreous cells developed in 1 day. Her vision decreased to counting fingers from 20/40, and intraocular pressure increased. After topical steroids and antiglaucomatous medications, her intraocular inflammation subsided. Her vision improved to 20/30, and intraocular pressure became normal in the right eye. CONCLUSIONS To our knowledge, this is the first case series documenting sterile endophthalmitis following intravitreal rituximab in vitreoretinal lymphoma. Recognition of sterile endophthalmitis is important in differentiating from vitreoretinal lymphoma recurrence and infectious endophthalmitis. Close observation and topical steroid drops seem to be effective.
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Affiliation(s)
- Buse Guneri Beser
- The Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Hakan Demirci
- The Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
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Marchese A, Di Biase C, Cicinelli MV, Menean M, Ferrari G, Bandello F, Modorati G, Goldstein DA, Miserocchi E. Anterior segment involvement in vitreoretinal lymphoma: clinical manifestations, molecular findings and in vivo confocal microscopy. Br J Ophthalmol 2024; 108:1168-1171. [PMID: 37963712 DOI: 10.1136/bjo-2023-324303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Intermediate and posterior manifestations of vitreoretinal lymphoma (VRL) are well characterised. However, there is limited information on anterior segment involvement in VRL. This study aimed to describe the anterior manifestations of VRL, and their association with molecular testing. METHODS Retrospective analysis of patients with biopsy-proven VRL. Study variables included anterior segment manifestations, findings from slit-lamp photos and in vivo confocal microscopy (IVCM) when available. MYD88 L265P mutation and cytology in the aqueous humour, retinal and systemic findings were also analysed. RESULTS The analysis included 108 eyes of 55 VRL patients. Anterior segment involvement was present in at least one visit in 55 eyes (51%) of 33 patients (60%); it included keratic precipitates (dendritiform with branching and irregular margins in 33 eyes, dust-like in 16 eyes and large granulomatous in 12 eyes), cells in the anterior chamber (51 eyes) and posterior synechiae (2 eyes). IVCM was available for 41 eyes and showed different morphologies of keratic precipitates, including floral, spikes and mulberry patterns (66%, 56% and 20%, respectively). MYD88 L265P mutation in the aqueous humour was detected in 10/21 (48%) eyes with no anterior segment involvement and 24/37 (65%) eyes with anterior segment involvement. CONCLUSIONS Anterior segment manifestations are often present in VRL and include dendritiform and dust-like keratic precipitates. IVCM in VRL can identify different patterns associated with keratic precipitates. MYD88 L265P mutation in the aqueous humour of VRL patients can also be found in eyes without significant anterior segment involvement.
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Affiliation(s)
- Alessandro Marchese
- Department of Ophthalmology, San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Carlo Di Biase
- Department of Ophthalmology, San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Menean
- Department of Ophthalmology, San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giulio Ferrari
- IRCCS San Raffaele Scientific Institute, Division of Neuroscience, Cornea and Ocular Surface Disease Unit, Eye Repair Laboratory, Milan, Italy
- Department Of Ophthalmology, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giulio Modorati
- Department of Ophthalmology, San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Debra Anne Goldstein
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Elisabetta Miserocchi
- Department of Ophthalmology, San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Menean M, Giuffrè C, Cicinelli MV, Marchese A, Modorati G, Bandello F, Miserocchi E. A comprehensive overview of diagnosis, imaging and treatment of vitreoretinal lymphoma. Eur J Ophthalmol 2024; 34:931-940. [PMID: 37956540 PMCID: PMC11295402 DOI: 10.1177/11206721231211931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023]
Abstract
Vitreoretinal lymphoma (VRL) is a rare B-cell intraocular neoplasia characterized by poor long-term prognosis and lack of effective therapies. It mainly involves the vitreous humor, the retina, and the retinal pigment epithelium (RPE), although anterior segment involvement can occur. VRL is classified as a lymphoma of immune privileged sites, along with testis lymphoma and primary central nervous system lymphoma (PCNSL). VRL and PCNSL are strictly connected indeed: 80% of VRL develop PCNSL, while 20% of patients with PCNSL present VRL during natural history of lymphoma. Due to the lack of worldwide consensus about diagnosis, therapy, and follow-up timing, VRL represents one of the most challenging ocular affections.VRL commonly masquerades as a posterior uveitis, and misdiagnosis often occurs because of partial response to topical steroids. Gold standard for diagnosis is cytological analysis of vitreous humor. However, this technique lacks sensitivity and supplemental molecular analyses can improve the diagnostic process. Multimodal imaging allows ophthalmologists to empower their clinical suspicion and a comprehensive examination can highlight typical features of VRL and justify further invasive procedures.There is no consensus about VRL therapy, and none of the therapeutical scheme has demonstrated to prevent cerebral involvement and improve patient's overall survival. Intravitreal injections of chemotherapeutics drugs, ocular radiation therapy and systemic chemotherapy can be considered in the treatment of VRL. Once cerebral involvement occurs, systemic chemotherapy must be included in the treatment as a life-saving therapy. Further multicentric studies are required to find out the best treatment of patients with VRL.
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Affiliation(s)
- Matteo Menean
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Giuffrè
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Marchese
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Modorati
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Miserocchi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Cole ED, Dedania V, Demirci H. Occlusive Vasculitis Following Intravitreal Rituximab Injection for Primary Vitreoretinal Lymphoma. Ocul Immunol Inflamm 2024:1-5. [PMID: 38913779 DOI: 10.1080/09273948.2024.2367270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 06/06/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE We report three cases of occlusive vasculitis following intravitreal rituximab therapy for biopsy-proven primary vitreoretinal lymphoma (PVRL), one of which was following an injection of the biosimilar Riabni (rituximab-arrx, AmGen) and two of which were following an injection of Rituxan (rituximab, Genentech). METHODS Case series. RESULTS Three cases of occlusive vasculitis confirmed with fluorescein angiography are reported 5 days, 8 days, and 3.5 weeks following intravitreal injection of rituximab. The initial vision was poor (20/500, 20/150, and light perception), but vision recovered to baseline in two cases, and remained poor in the case of combined artery and vein occlusion. CONCLUSION Occlusive vasculitis is a rarely reported but potential complication of intravitreal rituximab therapy in patients who have been previously treated with the agent and may have delayed onset. A low threshold for fluorescein angiography as a diagnostic test for post-injection vision loss and prompt treatment with topical and/or oral steroids should be considered.
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Affiliation(s)
- Emily D Cole
- Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Vaidehi Dedania
- NYU Langone Health Department of Ophthalmology, New York University Langone Health, New York, New York, USA
| | - Hakan Demirci
- Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
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Gao J, Peng X, Wang L. Efficacy and safety of first-line combination therapy versus monotherapy for vitreoretinal lymphoma: a systematic review and meta-analysis. BMC Ophthalmol 2023; 23:477. [PMID: 37993841 PMCID: PMC10664658 DOI: 10.1186/s12886-023-03226-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Vitreoretinal lymphoma (VRL) is usually treated with a combination of intraocular methotrexate (ioMTX), high-dose intravenous methotrexate (HD-MTX), or local radiotherapy (RT) as the first options. The effectiveness and safety of monotherapy like bruton's tyrosine kinase inhibitors (BTKi) for PVRL remain uncertain. METHODS A systematic review and meta-analysis of clinical trial data and conference abstracts in VRL patients treated with first-line combination therapy or monotherapy were conducted through a search of PubMed, Embase, and Scopus databases until December 2022. A total of 24 studies comprising 517 patients were included, and survival data were extracted from 279 patients due to inconsistent units across studies. RESULTS The combined treatment group used ioMTX + chemotherapy (in 4 studies), RT + chemotherapy (in 2 studies), ioMTX/HD-MTX based regimen (in 2 studies), ioMTX + RT + chemotherapy (in 2 studies), ioMTX + lenalidomide/BTKi (in 2 studies) and combination of multiple therapies (in 7 studies). The monotherapy group was mainly treated with oral monotherapies such as BTKi. The combination therapy had a higher overall response rate (ORR) and complete response rate (CRR) than monotherapy (ORR: 96% vs. 72%, CRR: 92% vs. 63%). Combination therapy also resulted in a longer median progression-free survival (28.8 months vs. 13 months, p = 0.012). However, the combination therapy group had more severe side effects (grade 3/4 toxicity) than the monotherapy group (45% vs. 8%). CONCLUSION The study showed combination therapy had better OR and CR rates, longer survival, and more toxicity than monotherapy. While BTK inhibitors were well-tolerated, long-term effectiveness needs confirmation from prospective studies. In addition, given the small number of studies of monotherapy for VRL, more studies are needed to validate its effects. TRIAL REGISTRATION CRD42023400305.
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Affiliation(s)
- Jing Gao
- Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Xiaoyan Peng
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
| | - Liang Wang
- Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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Buonfiglio F, Pfeiffer N, Gericke A. Immunomodulatory and Antioxidant Drugs in Glaucoma Treatment. Pharmaceuticals (Basel) 2023; 16:1193. [PMID: 37765001 PMCID: PMC10535738 DOI: 10.3390/ph16091193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/02/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
Glaucoma, a group of diseases characterized by progressive retinal ganglion cell loss, cupping of the optic disc, and a typical pattern of visual field defects, is a leading cause of severe visual impairment and blindness worldwide. Elevated intraocular pressure (IOP) is the leading risk factor for glaucoma development. However, glaucoma can also develop at normal pressure levels. An increased susceptibility of retinal ganglion cells to IOP, systemic vascular dysregulation, endothelial dysfunction, and autoimmune imbalances have been suggested as playing a role in the pathophysiology of normal-tension glaucoma. Since inflammation and oxidative stress play a role in all forms of glaucoma, the goal of this review article is to present an overview of the inflammatory and pro-oxidant mechanisms in the pathophysiology of glaucoma and to discuss immunomodulatory and antioxidant treatment approaches.
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Affiliation(s)
- Francesco Buonfiglio
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany;
| | | | - Adrian Gericke
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany;
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7
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Croley CR, Pumarol J, Delgadillo BE, Cook AC, Day F, Kaceli T, Ward CC, Husain I, Husain A, Banerjee S, Bishayee A. Signaling pathways driving ocular malignancies and their targeting by bioactive phytochemicals. Pharmacol Ther 2023:108479. [PMID: 37330112 DOI: 10.1016/j.pharmthera.2023.108479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
Ocular cancers represent a rare pathology. The American Cancer Society estimates that 3,360 cases of ocular cancer occur annually in the United States. The major types of cancers of the eye include ocular melanoma (also known as uveal melanoma), ocular lymphoma, retinoblastoma, and squamous cell carcinoma. While uveal melanoma is one of the primary intraocular cancers with the highest occurrence in adults, retinoblastoma remains the most common primary intraocular cancer in children, and squamous cell carcinoma presents as the most common conjunctival cancer. The pathophysiology of these diseases involves specific cell signaling pathways. Oncogene mutations, tumor suppressor mutations, chromosome deletions/translocations and altered proteins are all described as causal events in developing ocular cancer. Without proper identification and treatment of these cancers, vision loss, cancer spread, and even death can occur. The current treatments for these cancers involve enucleation, radiation, excision, laser treatment, cryotherapy, immunotherapy, and chemotherapy. These treatments present a significant burden to the patient that includes a possible loss of vision and a myriad of side effects. Therefore, alternatives to traditional therapy are urgently needed. Intercepting the signaling pathways for these cancers with the use of naturally occurring phytochemicals could be a way to relieve both cancer burden and perhaps even prevent cancer occurrence. This research aims to present a comprehensive review of the signaling pathways involved in various ocular cancers, discuss current therapeutic options, and examine the potential of bioactive phytocompounds in the prevention and targeted treatment of ocular neoplasms. The current limitations, challenges, pitfalls, and future research directions are also discussed.
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Affiliation(s)
- Courtney R Croley
- Healthcare Corporation of America, Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Hudson, FL 34667, USA
| | - Joshua Pumarol
- Ross University School of Medicine, Miramar, FL 33027, USA
| | - Blake E Delgadillo
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA
| | - Andrew C Cook
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA
| | - Faith Day
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA
| | - Tea Kaceli
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA
| | - Caroline C Ward
- Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA
| | - Imran Husain
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Erie, PA 16509, USA
| | - Ali Husain
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Erie, PA 16509, USA
| | - Sabyasachi Banerjee
- Department of Pharmaceutical Chemistry, Gupta College of Technological Sciences, Asansol 713 301, India
| | - Anupam Bishayee
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA.
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8
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McAllister MA, Moore SM, Harris AE. Intravitreal Rituximab-Associated Retinal Occlusive Vasculitis. JOURNAL OF VITREORETINAL DISEASES 2023; 7:160-164. [PMID: 37006669 PMCID: PMC10037759 DOI: 10.1177/24741264221123440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Purpose To describe a 90-year-old patient who was referred to a private retina specialist with gradually worsening vision and floaters in the left eye. Methods A retrospective case report is presented. Results The patient was treated with intravitreal rituximab injections for intraocular lymphoma with resulting vision loss to the level of hand motions from severe granulomatous uveitis and retinal occlusive vasculitis. Conclusions Retinal occlusive vasculopathy secondary to rituximab intravitreal injections is a rare clinical entity with only a single previous case reported in the literature. However, there are reports of systemic vasculitis after systemic administration of rituximab. Clinicians should be aware of the possibility of ocular hypertension, granulomatous anterior uveitis, and/or retinal occlusive vasculitis after intravitreal rituximab use. Consideration should be given to the inflammatory risk of rituximab intravitreal injections to reduce the potential for treatment-induced vision loss.
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Affiliation(s)
- Mark A. McAllister
- Department of Ophthalmology and Vision
Science, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Spencer M. Moore
- Department of Ophthalmology and Vision
Science, University of Arizona College of Medicine, Tucson, AZ, USA
| | - April E. Harris
- Department of Ophthalmology and Vision
Science, University of Arizona College of Medicine, Tucson, AZ, USA
- Retina Associates Southwest, Tucson, AZ,
USA
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Hoang-Xuan K, Deckert M, Ferreri AJM, Furtner J, Gallego Perez-Larraya J, Henriksson R, Hottinger AF, Kasenda B, Lefranc F, Lossos A, McBain C, Preusser M, Roth P, Rudà R, Schlegel U, Soffietti R, Soussain C, Taphoorn MJB, Touitou V, Weller M, Bromberg JEC. European Association of Neuro-Oncology (EANO) guidelines for treatment of primary central nervous system lymphoma (PCNSL). Neuro Oncol 2023; 25:37-53. [PMID: 35953526 PMCID: PMC9825335 DOI: 10.1093/neuonc/noac196] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Indexed: 01/12/2023] Open
Abstract
The management of primary central nervous system (PCNSL) is one of the most controversial topics in neuro-oncology because of the complexity of the disease and the limited number of controlled studies available. In 2021, given recent advances and the publication of practice-changing randomized trials, the European Association of Neuro-Oncology (EANO) created a multidisciplinary task force to update the previously published evidence-based guidelines for immunocompetent adult patients with PCNSL and added a section on immunosuppressed patients. The guideline provides consensus considerations and recommendations for the treatment of PCNSL, including intraocular manifestations and specific management of the elderly. The main changes from the previous guideline include strengthened evidence for the consolidation with ASCT in first-line treatment, prospectively assessed chemotherapy combinations for both young and elderly patients, clarification of the role of rituximab even though the data remain inconclusive, of the role of new agents, and the incorporation of immunosuppressed patients and primary ocular lymphoma. The guideline should aid the clinicians in everyday practice and decision making and serve as a basis for future research in the field.
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Affiliation(s)
- Khê Hoang-Xuan
- APHP, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière; Sorbonne Université; IHU; ICM. Paris, France
| | - Martina Deckert
- Institute of Neuropathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Julia Furtner
- Department of Biomedical and Imaging Image-guided Therapy Medical University of Vienna, Vienna, Austria
| | - Jaime Gallego Perez-Larraya
- Health Research Institute of Navarra (IdiSNA), Program in Solid Tumors, Foundation for the Applied Medical Research, Department of Neurology, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Roger Henriksson
- Department of Radiation Sciences, Oncology, University of Umeå, S-901 85 Umea, Sweden
| | - Andreas F Hottinger
- Department of Oncology and Clinical Neurosciences, CHUV University Hospital Lausanne and University of Lausanne, LausanneSwitzerland
| | - Benjamin Kasenda
- Department of Hematology/Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
| | - Florence Lefranc
- Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, Belgium
| | - Alexander Lossos
- Head, Leslie and Michael Gaffin Center for Neuro-Oncology; Department of Oncology and Neurology; Hadassah-Hebrew University Medical Center; Jerusalem, Israel
| | - Catherine McBain
- Department of Clinical Oncology, The Christie NHS FT; Manchester; United Kingdom
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna,Austria
| | - Patrick Roth
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Roberta Rudà
- Department of Neurology, Castelfranco Veneto/Treviso Hospital, Italy
- Division of Neuro-Oncology, Department of Neuroscience, University of Turin, and City of Health and Science University Hospital, Turin, Italy
| | - Uwe Schlegel
- Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Germany
| | - Riccardo Soffietti
- Division of Neuro-Oncology, Department of Neuroscience, University of Turin, and City of Health and Science University Hospital, Turin, Italy
| | - Carole Soussain
- Department of Hematology, Institut Curie, Site Saint-Cloud, France and INSERM U932 Institut Curie, PSL Research University, Paris, France
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center and Department of Neurology, Haaglanden Medical Center The Hague, The Netherlands
| | - Valérie Touitou
- APHP, Department of Ophtalmology, Groupe Hospitalier Pitié-Salpêtrière; Sorbonne Université. Paris, France
| | - Michael Weller
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jacoline E C Bromberg
- Department of Neuro-Oncology, Erasmus MC University Medical Center Cancer Institute, Rotterdam. The Netherlands
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Xu C, Prager AJ, Alonso CD, Pawar AS. Insights From the Eye for Patients With Kidney Transplant. Transplant Proc 2022; 54:2182-2191. [PMID: 36096946 DOI: 10.1016/j.transproceed.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/12/2022] [Indexed: 11/29/2022]
Abstract
The eye and the kidney share structural and developmental similarities on a cellular and clinical level, and they are often affected by the same disease processes. Performing an eye exam to look for signs of conditions such as hypertension and diabetes can provide a helpful window into the health of the kidney. Patients with kidney transplants (KT) are a unique population that require close monitoring. These patients are maintained on a number of immunosuppressive medications and may face complications such as medication side effects, infections, and graft rejection. Patients with KT are at higher risk of both infectious and noninfectious eye conditions related to underlying systemic disease or use of immunosuppressive medications. Screening for eye conditions is important because preserving visual function is integral to quality of life, and also because the eye exam can help with early detection and treatment of systemic conditions. Here we describe some of the common eye findings and conditions in patients with KT. We recommend that patients with KT receive annual eye exams, and we hope that the information provided here can help nephrologists become more familiar with eye findings and identify situations where a referral to ophthalmology is warranted.
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Affiliation(s)
| | - Alisa J Prager
- Harvard Medical School, Boston, Massachusetts; Division of Ophthalmology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Carolyn D Alonso
- Harvard Medical School, Boston, Massachusetts; Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Aditya S Pawar
- Harvard Medical School, Boston, Massachusetts; Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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11
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Schiemenz C, Lüken S, Klassen AM, Ranjbar M, Illerhaus G, Fend F, Heindl LM, Chronopoulos A, Grisanti S, Kakkassery V. [Clinical procedures for intraocular lymphomas]. DIE OPHTHALMOLOGIE 2022; 119:675-685. [PMID: 35925411 DOI: 10.1007/s00347-022-01651-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The classification of intraocular lymphomas is based on their anatomical location. They are divided into uveal lymphomas with involvement of the choroid, ciliary body or iris and vitreoretinal lymphomas with isolated or combined involvement of the vitreous body and/or retina. Over the last decades it has become increasingly possible to work out the clinical and pathobiological features of the various subtypes, thereby reducing the diagnostic hurdles and creating improved treatment options. OBJECTIVE A summary of the various types of intraocular lymphoma in terms of clinical features, diagnostics, treatment and prognosis is given as well as recommendations for follow-up care. METHODS A selective literature search was carried out on the subject of intraocular lymphomas using PubMed and Google Scholar. RESULTS Intraocular lymphomas affect different structures, so that the symptoms can also be very different. The diagnostic spectrum ranges from typical ocular examination methods to sample biopsies with subsequent cytological, histological and molecular pathological processing. The treatment pillars available are percutaneous irradiation and intravitreal drug administration as local treatment and systemic treatment or a combination of systemic and local treatment. The prognosis depends mainly on the subtype of the lymphoma and the extent of the infestation when the diagnosis is confirmed. Even though some effective treatment options are now available, it has not yet been possible to significantly reduce the mortality rate. CONCLUSION Many different options are available for the diagnostics and treatment of intraocular lymphomas, which require close interdisciplinary cooperation. The further developments in the field of molecular pathology allow a faster and more accurate diagnosis and could open up new treatment options in the future.
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Affiliation(s)
- C Schiemenz
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - S Lüken
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - A M Klassen
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - M Ranjbar
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - G Illerhaus
- Klinik für Hämatologie, Onkologie, Stammzelltransplantation und Palliativmedizin, Klinikum der Landeshauptstadt Stuttgart gKAöR | Standort Mitte, Katharinenhospital, Stuttgart, Deutschland
- Stuttgart Cancer Center, Tumorzentrum Eva Mayr-Stihl, Stuttgart, Deutschland
| | - F Fend
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
- Comprehensive Cancer Center, Tübingen-Stuttgart, Deutschland
| | - L M Heindl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universitätsklinikum Köln, Universität zu Köln, Köln, Deutschland
- Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
| | - A Chronopoulos
- Augenklinik, Klinikum Ludwigshafen, Ludwigshafen, Deutschland
| | - S Grisanti
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - V Kakkassery
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
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12
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Central Nervous System Progression in Primary Vitreoretinal Lymphoma with Bilateral and Unilateral Involvement: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14122967. [PMID: 35740632 PMCID: PMC9221335 DOI: 10.3390/cancers14122967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Primary vitreoretinal lymphoma (PVRL) is a rare disease with high mortality rates. It has a poor prognosis mainly because of its tendency to spread to the central nervous system (CNS). The optimal treatment strategy for PVRL is unknown; ideally, a treatment should prevent spread to the CNS, and thereby prolong overall survival. PVRL may occur in one eye (unilateral PVRL), or in both (bilateral). We reviewed studies from the scientific literature to investigate whether the risk of CNS progression differs between bilateral and unilateral PVRL. The quality of most available studies was moderate, at best. From the available studies, we found no difference in the development of CNS disease between patients with bilateral PVRL and unilateral PVRL. Abstract Background: Primary vitreoretinal lymphoma (PVRL) is either unilateral or bilateral at initial presentation. Progression to a central nervous system (CNS) lymphoma is regularly observed and these patients seem to have an inferior survival. Knowledge of the predictive value of laterality for CNS progression may facilitate risk stratification and the development of more effective treatment strategies, and eventually, improve outcomes. The objective of this analysis is to estimate the risk of CNS progression for patients with bilateral versus unilateral involvement of PVRL. Methods: Systematic literature search for studies on CNS progression in PVRL with bilateral and unilateral involvement according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We assessed the risk of bias and the methodological quality of studies using the Quality in Prognosis Studies (QUIPS) tool. Risk ratios of CNS progression in PVRL with bilateral and unilateral involvement were calculated and combined via a meta-analysis. Results: Twenty-five small-sized (total n = 371 cases) studies were included. The majority of the studies were at medium to high risk of bias. Results suggest no significant difference in CNS progression between bilateral and unilateral PVRL, with a pooled relative risk ratio of 1.12 (95% confidence interval 0.89–1.41). Conclusions: CNS progression is common in PVRL. From the limited available evidence, there is no significant difference in CNS progression between bilateral and unilateral PVRL.
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13
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Hasan N, Chawla R, Shaikh N, Kandasamy S, Azad SV, Sundar MD. A comprehensive review of intravitreal immunosuppressants and biologicals used in ophthalmology. Ther Adv Ophthalmol 2022; 14:25158414221097418. [PMID: 35602659 PMCID: PMC9121505 DOI: 10.1177/25158414221097418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 04/11/2022] [Indexed: 12/18/2022] Open
Abstract
Systemic immunosuppressants and biologicals have been a valuable tool in the
treatment of inflammatory diseases and malignancies. The safety profile of these
drugs has been debatable, especially in localized systems, such as the eye. This
has led to the search for fairly local approaches, such as intravitreal,
subconjunctival, and topical route of administration. Immunosuppressants have
been used as a second-line drug in patients intolerable to corticosteroids or
those who develop multiple recurrences on weaning corticosteroids. Similarly,
biologicals have also been used as the next line of therapy, when adequate
control of inflammation could not be attained or immunosuppressants were
contraindicated to patients. Intravitreal immunosuppressants, such as
methotrexate and sirolimus, have been extensively studied in noninfectious
posterior uveitis, whereas limited studies have established the efficacy of
intravitreal biologicals, such as infliximab and adalimumab. Most of these drugs
have shown good safety profile and tolerability in animal studies alone and have
not been studied further in human subjects. However, most of the studies in
literature are single-case reports or case series which limits the level of
evidence. In this comprehensive review, we discuss the mechanism of action,
pharmacodynamics, pharmacokinetics, indications, efficacy, and side effects of
different intravitreal immunosuppressants and biologicals that have been studied
in literature.
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Affiliation(s)
- Nasiq Hasan
- All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Rohan Chawla
- Associate Professor, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, New Delhi 110029, India
| | - Nawazish Shaikh
- All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | | | | | - M. Dheepak Sundar
- All India Institute of Medical Sciences, New Delhi, New Delhi, India
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14
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Raval V, Binkley E, Aronow ME, Valenzuela J, Peereboom DM, Wei W, Srivastava S, Davanzo J, Boldt HC, McGarrey MP, Papaliodis GN, Sobrin L, Kim IK, Vavvas DG, Eliott D, Nayak L, Dodds E, Marco del Pont F, Singh AD. Primary central nervous system lymphoma: Inter‐compartmental progression. EJHAEM 2022; 3:362-370. [PMID: 35846050 PMCID: PMC9175875 DOI: 10.1002/jha2.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Vishal Raval
- Department of Ophthalmic Oncology Cole Eye Institute Cleveland Clinic Cleveland Ohio USA
| | - Elaine Binkley
- Department of Ophthalmology and Visual Sciences University of Iowa Iowa City Iowa USA
| | - Mary E. Aronow
- Retina Service, Massachusetts Eye and Ear Harvard Medical School Boston Massachusetts USA
| | - Juan Valenzuela
- Department of Retina and Ophthalmic Oncology Consultores Oftalmológicos Buenos Aires Argentina
| | - David M. Peereboom
- The Rose Ella Burkhardt Brain Tumor and Neuro‐Oncology Center Cleveland Clinic Cleveland Ohio USA
| | - Wei Wei
- Department of Quantitative Health Sciences Lerner Research Institute Cleveland Clinic Cleveland Ohio USA
| | - Sunil Srivastava
- Department of Ophthalmic Oncology Cole Eye Institute Cleveland Clinic Cleveland Ohio USA
| | - Jaqueline Davanzo
- Department of Ophthalmic Oncology Cole Eye Institute Cleveland Clinic Cleveland Ohio USA
| | - Herbert Culver Boldt
- Department of Ophthalmology and Visual Sciences University of Iowa Iowa City Iowa USA
| | - Mark P. McGarrey
- Retina Service, Massachusetts Eye and Ear Harvard Medical School Boston Massachusetts USA
| | - George N. Papaliodis
- Retina Service, Massachusetts Eye and Ear Harvard Medical School Boston Massachusetts USA
| | - Lucia Sobrin
- Retina Service, Massachusetts Eye and Ear Harvard Medical School Boston Massachusetts USA
| | - Ivana K. Kim
- Retina Service, Massachusetts Eye and Ear Harvard Medical School Boston Massachusetts USA
| | - Dimitrios G. Vavvas
- Retina Service, Massachusetts Eye and Ear Harvard Medical School Boston Massachusetts USA
| | - Dean Eliott
- Retina Service, Massachusetts Eye and Ear Harvard Medical School Boston Massachusetts USA
| | - Lakshmi Nayak
- Center for Neuro‐Oncology Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Emilio Dodds
- Department of Retina and Ophthalmic Oncology Consultores Oftalmológicos Buenos Aires Argentina
| | | | - Arun D. Singh
- Department of Ophthalmic Oncology Cole Eye Institute Cleveland Clinic Cleveland Ohio USA
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15
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S Mehta N, Emami-Naeini P. A Review of Systemic Biologics and Local Immunosuppressive Medications in Uveitis. J Ophthalmic Vis Res 2022; 17:276-289. [PMID: 35765634 PMCID: PMC9185190 DOI: 10.18502/jovr.v17i2.10804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 01/15/2023] Open
Abstract
Uveitis is one of the most common causes of vision loss and blindness worldwide. Local and/or systemic immunosuppression is often required to treat ocular inflammation in noninfectious uveitis. An understanding of safety and efficacy of these medications is required to individualize treatment to each patient to ensure compliance and achieve the best outcome. In this article, we reviewed the effectiveness of systemic biologic response modifiers and local treatments commonly used in the management of patients with noninfectious uveitis.
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Affiliation(s)
- Neesurg S Mehta
- Department of Ophthalmology and Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Parisa Emami-Naeini
- Department of Ophthalmology and Vision Science, University of California, Davis, Sacramento, CA, USA
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16
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Gong D, Aronow ME, Eliott D. Rapid, Spontaneous Resolution of Prominent Subretinal Infiltrate in Vitreoretinal Lymphoma. JOURNAL OF VITREORETINAL DISEASES 2022; 6:80-85. [PMID: 37007723 PMCID: PMC9976220 DOI: 10.1177/24741264211009804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: This case report describes a patient with vitreoretinal lymphoma who subacutely developed a large, peripapillary subretinal infiltrate that rapidly and spontaneously resolved. Methods: A case report is presented. Results: A 65-year-old Asian-American woman was referred for evaluation of a dense, peripapillary subretinal infiltrate in the left eye. A diagnostic vitrectomy revealed large, atypical lymphocytes with irregularly shaped nuclei, and mutational testing was positive for myeloid differentiation primary response 88 ( MYD88). Prior to surgery, the patient’s subretinal infiltrate had begun to resolve spontaneously, a process that continued after surgery without initiation of systemic or local ocular therapy. Conclusions: Patients with vitreoretinal lymphoma may present with transient, subretinal infiltrates that can resolve without treatment.
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Affiliation(s)
- Dan Gong
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Mary E. Aronow
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Dean Eliott
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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17
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Primary vitreoretinal lymphoma: A diagnostic and management challenge. Blood 2021; 138:1519-1534. [PMID: 34036310 DOI: 10.1182/blood.2020008235] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 04/22/2021] [Indexed: 11/20/2022] Open
Abstract
Primary vitreoretinal lymphoma (PVRL) is a rare form of primary central nervous system lymphoma (PCNSL) arising in the intraocular compartment without brain involvement. Despite its apparent indolent clinical course, PVRL can cause permanent vision loss and CNS relapse, the major cause of death in PVRL patients. The pathophysiology of PVRL is unknown. As in PCNSL, the transformation of the tumor cells likely originates outside the CNS, before the cells migrate to the eye and proliferate within an immune-permissive microenvironment. PVRL exhibits a biased immunoglobulin repertoire, suggesting underlying antigen selection. The diagnosis remains challenging, requiring close coordination between ophthalmologists and cytologists. Because of their rarity and fragility in the vitreous, lymphoma cells cannot always be identified. Interleukin levels, molecular biology and imaging are used in combination with clinical ophthalmological examination to support the diagnosis of PVRL. Multi-institutional prospective studies are urgently needed to validate the equivocal conclusions regarding treatments drawn from heterogeneous retrospective or small cohort studies. Intravitreal injections of methotrexate or rituximab or local radiotherapy are effective at clearing tumor cells within the eyes but do not prevent CNS relapse. Systemic treatment based on high-dose methotrexate chemotherapy, with or without local treatment, might reduce this risk. At relapse, intensive consolidation chemotherapy followed by stem cell transplantation can be considered. Single-agent ibrutinib, lenalidomide and temozolomide treatments are effective in patients with relapsed PVRL and should be tested as first-line treatments. Therapeutic response assessment based on a clinical examination is improved by measuring cytokine levels but still needs to be refined.
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18
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Raval V, Binkley E, Aronow ME, Valenzuela J, Peereboom DM, Singh AD. Primary central nervous system lymphoma - ocular variant: an interdisciplinary review on management. Surv Ophthalmol 2021; 66:1009-1020. [PMID: 33762182 DOI: 10.1016/j.survophthal.2021.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 12/26/2022]
Abstract
Primary central nervous system lymphoma-ophthalmic variant (PCNSL-O) is an ocular subset of PCNSL predominantly involving subretinal pigment epithelium space, retina, and vitreous. The ophthalmic manifestations can precede, occur simultaneously, or follow other compartments of the CNS. Clinical trials have resulted in a significantly improved outcome in PCNSL patients over the past 2 decades, with a higher proportion of patients receiving frontline high dose methotrexate-based polychemotherapy regimens with curative intent; however, the current management of PCNSL-O remains controversial owing to lack of prospective data. The goals of PCNSL-O treatment are both to achieve local (ocular) control and to prevent tumor-specific mortality from further CNS involvement. Despite achieving high rates of ocular control with intravitreal agents like methotrexate and rituximab, the overall survival is poor, as 65-85% of patients eventually succumb to CNS disease. Few studies define the role of systemic chemotherapy with/without local treatment as a first line induction treatment for PCNSL-O considering limiting factors such as ocular penetration of systemically administered drugs and treatment related neurotoxicity. Also, the role of adjuvant treatment for PCNSL-O to prevent CNS progression and to improve overall survival is unknown. In this systematic review of the literature, we analyze treatment outcomes of various regimens (local, systemic, and combination) in terms of local control, CNS progression, and overall survival.
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Affiliation(s)
- Vishal Raval
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Elaine Binkley
- Department of Ophthalmology & Visual Sciences, University of Iowa, Iowa City, IA, USA
| | - Mary E Aronow
- Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Juan Valenzuela
- Department of Retina and Ophthalmic Oncology, Consultores Oftalmológicos, Buenos Aires, Argentina
| | - David M Peereboom
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Arun D Singh
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
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19
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Rishi P, Manchegowda PT, Gondhale HP, Rishi E, Das K, Krishnakumar S, Raja T, Biswas J. Intravitreal rituximab monotherapy for management of eyes with vitreoretinal lymphoma: initial experience from India. Int Ophthalmol 2021; 41:2495-2504. [PMID: 33730314 DOI: 10.1007/s10792-021-01805-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/09/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate treatment outcomes and complications of intravitreal rituximab (IVR) monotherapy for eyes with vitreoretinal lymphoma (VRL). METHODS Patients diagnosed with 'isolated primary VRL' or 'VRL with remission of systemic disease' and treated with IVR (1 mg/0.1 ml) between June 2014 and June 2019 were included in this retrospective, interventional case series. Injections were repeated at monthly intervals until complete resolution. All patients signed a written informed consent form. Institutional review board approval was obtained. RESULTS Twelve eyes of 7 patients with VRL were treated with 77 IVR injections at mean 6.42 injections per eye (median = 5; range = 2-13) for complete resolution at mean 8.16 ± 4.62 months (median = 6.97 months; range = 1.97-14.33 months). Mean age at presentation was 53.3 years (median = 54 years; range = 34-74 years). Patients were co-managed with medical oncologist and periodically evaluated. Complications included anterior uveitis (n = 6), raised intraocular pressure (n = 3), posterior synechiae (n = 2), vitreous haemorrhage (n = 1), pre-retinal haemorrhage (n = 1), retinal detachment (n = 1), posterior subcapsular cataract (n = 2) and sectoral iris atrophy (n = 1). Recurrences were seen in 3 eyes (25%), which eventually achieved complete resolution with treatment. None of the patients had systemic involvement or death during follow-up. Mean follow-up was 18.73 ± 8.83 months (median = 21.60 months; range = 7.37-32.67 months). CONCLUSION Intravitreal rituximab monotherapy is effective in management of vitreoretinal lymphoma in patients with isolated ocular disease.
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Affiliation(s)
- Pukhraj Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, 600006, India.
| | - Pradeep T Manchegowda
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, 600006, India
| | - Harshal P Gondhale
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, 600006, India
| | - Ekta Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, 600006, India
| | - Kalpita Das
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, 600006, India
| | - Subramanian Krishnakumar
- L&T Ocular Pathology Department, Medical Research Foundation, 18 College Road, Chennai, Tamilnadu, 600006, India
| | - Thirumalairaj Raja
- Apollo Speciality Hospitals, 8 Cenotaph Road, Rathna Nagar Alwarpet, Chennai, Tamil Nadu, 600018, India
| | - Jyotirmay Biswas
- L&T Ocular Pathology Department, Medical Research Foundation, 18 College Road, Chennai, Tamilnadu, 600006, India
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20
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Moon J, Choi SH, Lee MJ, Jo DH, Park UC, Yoon SO, Woo SJ, Oh JY. Ocular surface complications of local anticancer drugs for treatment of ocular tumors. Ocul Surf 2020; 19:16-30. [PMID: 33238207 DOI: 10.1016/j.jtos.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 02/03/2023]
Abstract
Local chemotherapy is increasingly used, either in combination with surgery or as monotherapy, for management of ocular tumors. Yet many of the local chemotherapeutic agents used for ocular tumors are cytotoxic drugs that are frequently associated with toxicities in normal ocular tissues. Understanding and managing these side effects are important because they affect treatment tolerability, outcome and quality of vision. Herein, we review local anticancer drugs administered for the treatment of ocular tumors, with an emphasis on their toxicities to the ocular surface, adnexa and lacrimal drainage system. We provide the underlying mechanisms and management strategies for the ocular side effects. Recent innovations in anticancer immunotherapy and ocular drug delivery systems also are discussed as new potential therapeutic modalities for alleviation of side effects.
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Affiliation(s)
- Jayoon Moon
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Se Hyun Choi
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 Beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, South Korea
| | - Min Joung Lee
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 Beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, South Korea
| | - Dong Hyun Jo
- Department of Anatomy and Cell Biology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Un Chul Park
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Sun-Ok Yoon
- R & D Lab, Eutilex Co., Ltd, Gasan Digital 1-ro 25, Geumcheon-gu, Seoul, 08594, South Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Department of Ophthalmology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Joo Youn Oh
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
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21
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Farrall AL, Smith JR. Eye involvement in primary central nervous system lymphoma. Surv Ophthalmol 2020; 65:548-561. [PMID: 32057762 DOI: 10.1016/j.survophthal.2020.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 12/18/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) may manifest initially in the eye (termed vitreoretinal lymphoma or VRL) or in non-ocular CNS compartments, or in both. The nature of the onset of PCNSL implies two clinical specialists - ophthalmologists and neuro-oncologists - independently may assess the primary presentation of this rare malignancy. Clinically relevant perspectives on expectations of PCNSL manifestation in both ocular and non-ocular CNS compartments would help inform management practices in each specialty, which should impact clinical outcomes. A recent increase in the number of published PCNSL cohort studies provides new opportunity to review the current prevalence rates of ocular involvement, and the timing of this involvement over the course of disease. In PCNSL cohorts defined by non-ocular CNS compartment involvement, with or without ocular involvement (termed "PCNSL ± ocular involvement" cohorts), mean rates of concomitant VRL at diagnosis, or at any time during the course, are 10% and 16%, respectively. Only a few individuals within this cohort group present with exclusive eye disease (<5%), and the rate of secondary ocular involvement is only 5-9%. In PCNSL cohorts defined by the involvement of the ocular compartment, with or without non-ocular CNS involvement (termed "VRL ± non-ocular CNS involvement" cohorts), 58% of persons have a primary ocular diagnosis, which carries a 50% risk of secondary involvement in the CNS beyond the eye. Rates of non-ocular CNS involvement with VRL at diagnosis or over the course of disease are 41% and 69%, respectively.
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Affiliation(s)
- Alexandra L Farrall
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.
| | - Justine R Smith
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.
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22
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M Castillejo Becerra C, Ding Y, Kenol B, Hendershot A, Meara AS. Ocular side effects of antirheumatic medications: a qualitative review. BMJ Open Ophthalmol 2020; 5:e000331. [PMID: 32154367 PMCID: PMC7045116 DOI: 10.1136/bmjophth-2019-000331] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/29/2019] [Accepted: 11/09/2019] [Indexed: 12/29/2022] Open
Abstract
Topic This paper reviews the ocular side effects of medications used in the treatment of rheumatological conditions. Clinical relevance Rheumatic diseases are inflammatory conditions that may affect the skin, blood vessels, joints, muscles and internal organs. Immunosuppressive agents are often used as treatment and while powerful, they carry side effects and toxicities that need careful monitoring. Ophthalmic complications have been reported with the use of antirheumatic medications; however, there is a lack of literature synthesising these reports. This paper addresses this gap and hopes to inform both rheumatologists and ophthalmologists as they work together on the management of patients with rheumatological conditions. Methods PubMed literature search was conducted from November to September 2019 searching for ocular side effects with the use of 25 rheumatological drugs. Results A total of 111 papers were included in this review. Adverse side effects were divided into non-infectious and infectious causes. Traditional disease-modifying antirheumatic drugs (DMARDs) were associated with pruritus, irritation and dryness of the conjunctiva while biologic DMARDS showed reports of new-onset/recurrent uveitis and demyelinating conditions. Infectious side effects included episodes of cytomegalovirus retinitis, toxoplasmic chorioretinitis and endophthalmitis. Other serious side effects were encountered and included in this review. Conclusion The goal of this paper is to inform healthcare providers about potential ocular side effects from rheumatological medications. Healthcare providers are encouraged to learn more about these ophthalmic complications and find relevance within their clinical practice.
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Affiliation(s)
| | - Yue Ding
- Division of Rheumatology and Immunology, Ohio State University, Columbus, Ohio, USA
| | - Beatrice Kenol
- Division of Rheumatology and Immunology, Ohio State University, Columbus, Ohio, USA
| | - Andrew Hendershot
- Department of Ophthalmology, Ohio State University, Columbus, Ohio, USA
| | - Alexa Simon Meara
- Division of Rheumatology and Immunology, Ohio State University, Columbus, Ohio, USA
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Kvopka M, Lake SR, Smith JR. Intraocular chemotherapy for vitreoretinal lymphoma: A review. Clin Exp Ophthalmol 2019; 48:240-248. [DOI: 10.1111/ceo.13668] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/18/2019] [Accepted: 10/20/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Michael Kvopka
- Flinders University College of Medicine and Public Health Adelaide South Australia Australia
| | - Stewart R. Lake
- Ophthalmology Unit – Division of Surgery, Flinders Medical Centre Adelaide South Australia Australia
| | - Justine R. Smith
- Flinders University College of Medicine and Public Health Adelaide South Australia Australia
- Ophthalmology Unit – Division of Surgery, Flinders Medical Centre Adelaide South Australia Australia
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Diaconita V, Rihani H, Mares V, Nehemy MB, Bakri SJ, Pulido JS. The use of anterior segment optical coherence tomography (ASOCT) in demonstrating recurrence of vitreoretinal lymphoma (VRL) in the anterior vitreous. Int J Retina Vitreous 2019; 5:19. [PMID: 31452937 PMCID: PMC6701086 DOI: 10.1186/s40942-019-0169-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background Primary vitreoretinal lymphoma (VRL) is a rare disease with 30-380 new cases in the United States per year. Its insidious process and spread to the central nervous system (CNS) leads to a mean 5-year survival rate from 41.4 to 71%. Medical treatment of VRL has been summarized extensively in the literature and involves intraocular rituximab and methotrexate as first line agents in unilateral VRL, with systemic chemotherapy to be considered in bilateral or CNS-involving disease. In addition, therapeutic "debulking" vitrectomy has been reported in the literature, with some limited success. Despite this, recurrence rate is high and should always be suspected in the setting of new inflammation. Anterior segment optical coherence tomography (ASOCT) has not been previously used to image VRL recurrence in the anterior vitreous. Case presentation A 63-year-old man, with VRL was found to have cells and debris in the anterior vitreous, 10 months after his first vitrectomy, intravitreal rituximab and methotrexate. Since the patient was phakic at the time of initial vitrectomy, the anterior vitreous had not been removed. ASOCT confirmed the findings. Subsequent surgery removed the lens and debris. Both the patient's vision and ASOCT improved. Conclusions We suggest that ASOCT of the anterior segment is a useful diagnostic tool to monitor for recurrence of VRL. In biopsy-proven VRL, phakic patients who undergo therapeutic vitrectomy, should also be considered for lens extraction and anterior vitrectomy to limit recurrences.
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Affiliation(s)
- Vlad Diaconita
- 1Department of Ophthalmology, Ivey Eye Institute, Western University, London, ON Canada
| | - Heba Rihani
- 2Department of Ophthalmology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
| | - Virginia Mares
- 2Department of Ophthalmology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
| | | | - Sophie J Bakri
- 2Department of Ophthalmology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
| | - Jose S Pulido
- 2Department of Ophthalmology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
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26
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Reddy V, Winslow R, Cao JH, Robertson ZM, Chen B, Ufret-Vincenty RL. Vitreoretinal lymphoma, secondary to non-CNS systemic lymphoma, masquerading as an infectious retinitis. Am J Ophthalmol Case Rep 2019; 16:100545. [PMID: 31468000 PMCID: PMC6711862 DOI: 10.1016/j.ajoc.2019.100545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 04/08/2019] [Accepted: 08/13/2019] [Indexed: 12/28/2022] Open
Abstract
Purpose To report an atypical case of vitreoretinal lymphoma, secondary to non-central nervous system (non-CNS) systemic lymphoma, masquerading as an infectious retinitis. Observations A 76-year-old female with a history of cecal diffuse large B-cell lymphoma with two prior occurrences of posterior segment ocular involvement presented with a complaint of blurry vision in the right eye. Exam findings were significant for large areas of retinal whitening and retinal hemorrhages in the absence of choroidal lesions or significant vitritis. The clinical suspicion of an infectious retinitis, was supported by a presumptive immunosuppressive state secondary to her recent treatment (within 1 month) with both intravitreal and systemic rituximab plus high-dose methotrexate. Aggressive treatment with intravitreal and systemic antivirals and antibiotics was initiated. However, polymerase chain reaction (PCR) testing of aqueous fluid was negative for cytomegalovirus (CMV), herpes simplex virus, herpes zoster virus and toxoplasma, and her condition continued to worsen, so suspicion was raised for a masquerading recurrent malignancy. She was treated empirically with serial intravitreal injections of methotrexate and showed dramatic clinical improvement. A subsequent relapse occurred that responded rapidly to intravitreal methotrexate in the absence of antiviral/antibiotics. Conclusion It is important for clinicians to be aware of atypical presentations of vitreoretinal lymphoma. This case emphasizes the fact that secondary ocular lymphoma after systemic lymphoma can have a vitreoretinal presentation rather than the more common choroidal involvement. Furthermore, it shows that recurrences of this disease in the same patient can have very different manifestations, including an appearance indistinguishable from a viral retinitis.
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Affiliation(s)
- Varun Reddy
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, 75390-9057, USA
| | - Richard Winslow
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, 75390-9057, USA
| | - Jennifer H Cao
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, 75390-9057, USA
| | - Zachary M Robertson
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, 75390-9057, USA
| | - Bo Chen
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, 75390-9057, USA.,Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, China
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Cicinelli MV, Marchese A, Miserocchi E, Giuffré C, Berchicci L, Querques G, Bandello F, Modorati GM. Retinal and Choroidal Changes of Vitreoretinal Lymphoma from Active to Remission Phase after Intravitreal Rituximab. Ocul Immunol Inflamm 2019; 28:637-646. [DOI: 10.1080/09273948.2019.1616769] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Maria Vittoria Cicinelli
- Ocular Immunology and Uveitis Service, Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy
| | - Alessandro Marchese
- Ocular Immunology and Uveitis Service, Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy
| | - Elisabetta Miserocchi
- Ocular Immunology and Uveitis Service, Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy
| | - Chiara Giuffré
- Ocular Immunology and Uveitis Service, Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy
| | - Luigi Berchicci
- Ocular Immunology and Uveitis Service, Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy
| | - Giuseppe Querques
- Ocular Immunology and Uveitis Service, Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Bandello
- Ocular Immunology and Uveitis Service, Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy
| | - Giulio Maria Modorati
- Ocular Immunology and Uveitis Service, Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy
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Castellino A, Pulido JS, Johnston PB, Ristow KM, Nora Bennani N, Inwards DJ, Macon WR, Micallef INM, King RL, Salomao DR, Witzig TE, Habermann TM, Nowakowski GS. Role of systemic high-dose methotrexate and combined approaches in the management of vitreoretinal lymphoma: A single center experience 1990-2018. Am J Hematol 2019; 94:291-298. [PMID: 30516868 DOI: 10.1002/ajh.25350] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 10/29/2018] [Accepted: 11/08/2018] [Indexed: 12/26/2022]
Abstract
Vitreoretinal lymphoma (VRL) management remains a challenge. We present 72 patients with VRL, diagnosed at Mayo Clinic between 1990-2018. Three nondiffuse large B-cell lymphoma (DLBCL) histology cases were excluded. Among 69 DLBCL, 33 patients had primary VRL (PVRL), 18 concurrent intraocular and central nervous system (CNS) or systemic disease and 18 secondary VRL. Patients received intraocular chemotherapy (intraocular injections of rituximab or metothrexate or steroids or in combination), radiotherapy, systemic or combined systemic plus intraocular treatment in 9, 10, 35, and 15 cases, respectively. Among primary and concurrent VRL, median failure free survival (FFS), CNS relapse-free survival (CNS-RFS) and overall survival (OS) were: 1.8, 4.9, and 4.1 years, respectively; among PVRL, median FFS, CNS-RFS, and OS were: 2.6 year, Not Reached and 9.3 year, respectively. No CNS relapse occurred beyond 4 years in PVRL. Median OS for patients diagnosed between 1990 and 1999 vs between 2000 and 2018 was 1.5 vs 9.4 years, respectively (P = .0002). OS was significantly higher in PVRL, as compared with concurrent VRL (P = .04). Previous immunosuppression and poor performance status were predictive of worse outcome. In PVRL, a combined systemic and intraocular therapy showed higher FFS (P = .002) and CNS-RFS (P = .003), but no differences in OS. Among 18 secondary VRL, at a median follow-up of 1.1 year after vitreoretinal relapse, median FFS and OS were 0.3 and 1.3 years. An improvement in survival of VRL has been observed over the decades. PVRL should undergo combined systemic and intraocular chemotherapy to prevent CNS progression.
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Affiliation(s)
| | - Jose S. Pulido
- Department of Ophthalmology; Mayo Clinic; Rochester Minnesota
| | | | - Kay M. Ristow
- Division of Hematology; Mayo Clinic; Rochester Minnesota
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Venkatesh R, Bavaharan B, Mahendradas P, Yadav NK. Primary vitreoretinal lymphoma: prevalence, impact, and management challenges. Clin Ophthalmol 2019; 13:353-364. [PMID: 30858685 PMCID: PMC6387616 DOI: 10.2147/opth.s159014] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Primary vitreoretinal lymphoma (PVRL) is a rare and potentially fatal intraocular malignancy. More than half of PVRL cases eventually involve the central nervous system (CNS). PVRL frequently masquerades as chronic uveitis. Advanced imaging tests, such as optical coherence tomography and fundus autofluorescence, have been applied in the diagnosis of PVRL. Histology and immunohistochemistry, in combination with molecular tests and IL-10 analysis, have been demonstrated as reliable in diagnosing PVRL. Mortality is high in patients with PVRL associated with CNS involvement, and relapses are common. The use of systemic chemotherapy in addition to the local therapies has proved to extend the mean survival time of these patients. Local therapies, including intravitreal injections of methotrexate and/or rituximab and low-dose radiotherapy to the eye, have been shown to be extremely effective in controlling intraocular lymphoma.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru - 560010, India,
| | - Bharathi Bavaharan
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru - 560010, India,
| | - Padmamalini Mahendradas
- Department of Uvea and Intraocular Inflammation, Narayana Nethralaya, Bengaluru - 560010, India
| | - Naresh Kumar Yadav
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru - 560010, India,
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30
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Kalogeropoulos D, Vartholomatos G, Mitra A, Elaraoud I, Ch'ng SW, Zikou A, Papoudou-Bai A, Moschos MM, Kanavaros P, Kalogeropoulos C. Primary vitreoretinal lymphoma. Saudi J Ophthalmol 2019; 33:66-80. [PMID: 30930667 PMCID: PMC6424706 DOI: 10.1016/j.sjopt.2018.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/03/2018] [Accepted: 12/30/2018] [Indexed: 11/30/2022] Open
Abstract
Primary vitreoretinal lymphoma (PVRL) is a rare ocular lymphoid malignancy, which consists a subset of primary central system lymphoma (PCNSL) and the most common type of intraocular lymphoma. The involvement of eyes is estimated to be approximately 20% of PCNSL, but the brain involvement may be up to 80% of PVRL. Typically, PVRL is a high grade B-cell malignancy of the retina and needs to be assorted from choroidal low-grade B-cell lymphomas. Very often PVRL masquerades and can be erroneously diagnosed as chronic uveitis, white dot syndromes or other neoplasms. Establishing an accurate diagnosis may involve cytology/pathology, immunohistochemistry, flow cytometry, molecular pathology and cytokine profile analysis. There is inadequate information about PVRL’s true incidence, ethnic/geographical variation and pathogenetic mechanisms. The therapeutic approach of PVRL involves aggressive chemotherapy and radiation therapy. Although PVRL tends to have a good response to the initial treatment, the prognosis is poor and the survival restricted due to the high relapse rates and CNS involvement.
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Affiliation(s)
- Dimitrios Kalogeropoulos
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom.,Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgios Vartholomatos
- Hematology Laboratory, Unit of Molecular Biology, University Hospital of Ioannina, Ioannina, Greece
| | - Arijit Mitra
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
| | | | - Soon Wai Ch'ng
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
| | - Anastasia Zikou
- Department of Radiology, Faculty of Medicine, School of Health Science, University of Ioannina, Greece
| | - Alexandra Papoudou-Bai
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Marilita M Moschos
- First Department of Ophthalmology, General Hospital of Athens G. Gennimatas, Medical School, National and Kapodistrian University of Athens, Greece
| | - Panagiotis Kanavaros
- Department of Anatomy-Histology-Embryology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Chris Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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31
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Liu DL, Zheng ZJ. Survival in B-cell primary ocular lymphoma 1997-2014: a population-based study. J Investig Med 2018; 66:1133-1140. [PMID: 29895584 PMCID: PMC6288687 DOI: 10.1136/jim-2018-000758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2018] [Indexed: 12/16/2022]
Abstract
This study sought to explore the prognostic factors in a large retrospective cohort of patients with B-cell primary ocular lymphoma (POL) from the Surveillance, Epidemiology, and End Results database. There were 2778 patients with B-cell POL whose complete clinical information was listed in the Surveillance, Epidemiology, and End Results database between 1997 and 2014. The epidemiology, therapeutic measures, and clinical characteristics were listed as descriptive statistics. Survival analysis was conducted by univariate and multivariable Cox regression models. Multivariate analysis identified age, lymphoma subtype, primary lesion, and radiation status as independent prognostic factors. For indolent lymphoma, radical treatment, especially intravenous chemotherapy, should be avoided. For invasive lymphoma, chemotherapy combined with full orbital irradiation is recommended. Radiotherapy alone or in combination with chemotherapy is superior to chemotherapy alone. These differences were statistically significant (p<0.05). Radiation brings benefits, with tolerable neurotoxicity, to patients with invasive B-cell POL. Radical tumor treatment may not be needed for patients with indolent B-cell POL.
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Affiliation(s)
- Deliang L Liu
- Department of Hematology, Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Zhuojun J Zheng
- Department of Hematology, Third Affiliated Hospital of Soochow University, Changzhou, China
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Citterio G, Calimeri T, Ferreri AJM. Challenges and prospects in the diagnosis and treatment of primary central nervous system lymphoma. Expert Rev Neurother 2018; 18:379-393. [PMID: 29633883 DOI: 10.1080/14737175.2018.1462700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Primary central nervous system lymphoma (PCNSL) retains peculiar biological and clinical characteristics and a worse prognosis with respect to other comparable lymphomas. The need for high doses of chemotherapy to achieve valid drug concentrations in cerebral tissues and/or radiotherapy results in severe treatment-related toxicities, mainly neurologic, which are frequently as disabling as the disease itself.Areas covered: Several emerging combined therapies are addressed that focus on treating PCNSL. The prognosis has improved in the last years but several questions remain unanswered and the research of more effective therapies goes on. Information and data were obtained from direct authors' experience and a PubMed search of recent peer-reviewed original articles, review articles, and clinical guidelines.Expert commentary: The substantial progress observed in PCNSL has to be ascribed to a carefully combination of standard chemotherapeutic drugs. High-dose methotrexate-based polychemotherapy followed by mainteinance therapy offers one of the best chances to control the disease. Major issues that deserve many efforts by researchers are the definition of optimal consolidation treatment and a shared management of specific conditions such as elderly population and intra-ocular localization.
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Affiliation(s)
- Giovanni Citterio
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Teresa Calimeri
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Andrés J M Ferreri
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milano, Italy
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Bata BM, Pulido JS, Patel SV, Khan SP, Salomao D, Boyce TG, Bothun ED. Combined intraocular and systemic rituximab for ocular lymphoproliferative disorder with extranodal marginal zone lymphoma-type morphology after heart transplant. J AAPOS 2018; 22:159-161. [PMID: 29408337 DOI: 10.1016/j.jaapos.2017.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 10/10/2017] [Accepted: 10/25/2017] [Indexed: 12/26/2022]
Abstract
Post-transplant lymphoproliferative disorder (PTLD) has rarely been associated with ocular manifestations. We report a case of bilateral ocular involvement by PTLD with histopathologic features of extranodal marginal zone (MALT) lymphoma in an 8-year-old boy following orthotopic heart transplantation. The anterior segment disease was treated successfully using a combination of intraocular and systemic injections of humanized anti-CD20 antibody (rituximab).
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Affiliation(s)
- Bashar M Bata
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Jose S Pulido
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Sanjay V Patel
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Shakila P Khan
- Department of Pediatric and Adolescent Medicine, Division of Hematology and Oncology, Mayo Clinic, Rochester, Minnesota
| | - Diva Salomao
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota; Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Thomas G Boyce
- Pediatric and Adolescent Medicine, Division of Infectious Diseases; Mayo Clinic, Rochester, Minnesota
| | - Erick D Bothun
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
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Wang Y, Cheung DS, Chan CC. Case 01-2017 - Primary vitreoretinal lymphoma (PVRL): report of a case and update of literature from 1942 to 2016. ACTA ACUST UNITED AC 2017; 2. [PMID: 30167573 DOI: 10.21037/aes.2017.06.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Primary vitreoretinal lymphoma (PVRL), as a subset of primary central nervous system lymphoma (PCNSL), is a rare and fatal ocular malignancy. Most PVRL masquerades as chronic posterior uveitis, which makes the clinical diagnosis challenging. Vitreous cells, subretinal lesions and imaging techniques are essential for clinical diagnosis. Importantly, cytopathology/histopathology identification of malignant cells is the gold standard for the diagnosis of PVRL. In addition, molecular detection of immunoglobulin heavy chain (IgH) or T cell receptor (TCR) gene rearrangements, immunophenotyping for cell markers, and cytokine analysis of interleukine-10 elevation are often used as adjunct procedures. Current management of PVRL involves local radiation, intravitreal chemotherapy (methotrexate and rituximab), with or without systemic chemotherapy depending on the involvement of non-ocular tissues. In cases with concomitant PCNSL, systemic high-dose methotrexate/rituximab based therapy in conjunction with local therapy, whole brain radiotherapy and/or autologous stem cell transplantation is considered. Although PVRL normally responds well to initial treatment, high rates of relapse and CNS involvement usually lead to poor prognosis and limited survival. A professional team of medical experts in ophthalmologists, ocular pathologists, neuro-oncologists and hemato-oncologists is essential for optimizing patient management.
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Affiliation(s)
- Yujuan Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Dik S Cheung
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Chi-Chao Chan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China.,Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Citterio G, Reni M, Gatta G, Ferreri AJM. Primary central nervous system lymphoma. Crit Rev Oncol Hematol 2017; 113:97-110. [DOI: 10.1016/j.critrevonc.2017.03.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/24/2017] [Accepted: 03/15/2017] [Indexed: 12/26/2022] Open
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Primary vitreoretinal lymphoma: an update on pathogenesis, diagnosis and treatment. Curr Opin Ophthalmol 2016; 27:177-84. [PMID: 26859131 DOI: 10.1097/icu.0000000000000255] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Primary vitreoretinal lymphoma (PVRL) is a subset of primary central nervous system lymphoma in which disease primarily affects the uvea, retina, vitreous and optic nerve. This review discusses recent efforts to clarify the disease's pathogenesis, its diagnosis and its optimal treatment. RECENT FINDINGS PVRL typically masquerades as a chronic intermediate uveitis in older individuals. Unambiguous diagnosis requires cytologic demonstration of malignant cells in a vitreous or chorioretinal specimen. However, cytokine analysis demonstrating increased interleukin 10 (IL 10) levels or increased IL-10:IL-6 ratio in the aqueous or vitreous, flow cytometry demonstrating a monoclonal cell population, molecular analysis demonstrating gene rearrangements or translocations or combinations of several techniques can be used effectively to aid in diagnosis. Treatment is aimed at eradication of disease within the eyes and prevention of central nervous system (CNS) lymphoma. Whether this should be done with local therapy alone (globe irradiation or intravitreal chemotherapy such as methotrexate or rituximab), or with systemic chemotherapy remains a source of debate. Even with high-dose systemic chemotherapy, CNS disease is prone to recurrence and has a poor prognosis. SUMMARY New techniques and innovative treatment strategies may streamline time to definitive diagnosis and may lead to prolonged survival with better vision in patients with PVRL.
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37
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You S, Luo J, Grossniklaus HE, Gou ML, Meng K, Zhang Q. Nanomedicine in the application of uveal melanoma. Int J Ophthalmol 2016; 9:1215-25. [PMID: 27588278 DOI: 10.18240/ijo.2016.08.20] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/16/2016] [Indexed: 12/28/2022] Open
Abstract
Rapid advances in nanomedicine have significantly changed many aspects of nanoparticle application to the eye including areas of diagnosis, imaging and more importantly drug delivery. The nanoparticle-based drug delivery systems has provided a solution to various drug solubility-related problems in ophthalmology treatment. Nanostructured compounds could be used to achieve local ocular delivery with minimal unwanted systematic side effects produced by taking advantage of the phagocyte system. In addition, the in vivo control release by nanomaterials encapsulated drugs provides prolong exposure of the compound in the body. Furthermore, certain nanoparticles can overcome important body barriers including the blood-retinal barrier as well as the corneal-retinal barrier of the eye for effective delivery of the drug. In summary, the nanotechnology based drug delivery system may serve as an important tool for uveal melanoma treatment.
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Affiliation(s)
- Shuo You
- Department of Endocrinology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China; Winship Cancer Institute, School of Medicine, Emory University, Atlanta, Georgia 30322, USA
| | - Jing Luo
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Hans E Grossniklaus
- Winship Cancer Institute, School of Medicine, Emory University, Atlanta, Georgia 30322, USA; Department of Ophthalmology, School of Medicine, Emory University, Atlanta, Georgia 30322, USA; Department of Pathology, School of Medicine, Emory University, Atlanta, Georgia 30322, USA
| | - Ma-Ling Gou
- State Key Laboratory of Biotherapy, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ke Meng
- State Key Laboratory of Biotherapy, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Qing Zhang
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China; Department of Ophthalmology, School of Medicine, Emory University, Atlanta, Georgia 30322, USA
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Zhou M, Xu G. Recent progress in the diagnosis and treatment of primary vitreoretinal lymphoma. Taiwan J Ophthalmol 2016; 6:170-176. [PMID: 29018736 PMCID: PMC5525622 DOI: 10.1016/j.tjo.2016.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 05/03/2016] [Accepted: 05/10/2016] [Indexed: 12/15/2022] Open
Abstract
Primary vitreoretinal lymphoma (PVRL) was previously termed primary intraocular lymphoma. PVRL is a potentially fatal intraocular malignancy, and 65-90% of PVRL cases eventually involve the central nervous system (CNS). The incidence of PVRL has been rising in both immunocompromised and immuno-competent populations worldwide. PVRL frequently masquerades as chronic uveitis. Advanced auxiliary examinations, such as optical coherence tomography and fundus autofluorescence have been applied in the diagnosis of PVRL. Histology and immunohistochemistry in combination with molecular tests and interleukin-10 analysis have been demonstrated as reliable in diagnosing PVRL. Despite early initiation of treatment, mortality is high with PVRL associated with CNS involvement and relapses are common. The use of systemic chemotherapy has not been proven to prevent CNS involvement; however, local therapies including intravitreal injections of methotrexate and/or rituximab and low-dose radiotherapy to the eye, has shown to be extremely effective in controlling intraocular lymphoma with encouraging results.
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Affiliation(s)
- Min Zhou
- Department of Ophthalmology, Fudan University Eye and ENT Hospital, Fudan University, Shanghai, PR China
| | - Gezhi Xu
- Department of Ophthalmology, Fudan University Eye and ENT Hospital, Fudan University, Shanghai, PR China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, PR China
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Abstract
The eye is a rare site for the development of malignant lymphoma. Based on cell type and involved intraocular structures, which as a whole represent an immune-privileged site, several subtypes of primary intraocular lymphoma need to be discerned. Primary vitreoretinal lymphoma (PVRL), the most common form, is an aggressive B-cell malignancy and considered a subtype of primary central nervous system (CNS) lymphoma. Ocular symptoms are non-specific and often mimic uveitis, frequently resulting in delayed diagnosis. Bilateral ocular involvement and dissemination/relapse in the CNS are common. Diagnosis of PVRL is usually based on the analysis of vitreous biopsy material. In addition to cytological and immunocytochemical examination, measurements of cytokine levels and molecular determination of B-cell clonality and recurrent mutations increase the diagnostic yield. Both systemic chemotherapy and exclusively local treatment, including ocular radiotherapy and intravitreal chemotherapy, are successful approaches for the management of PVRL, although it is currently not predictable which patients require systemic treatment in order to avoid cerebral dissemination, a complication associated with a considerably worse prognosis.
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Affiliation(s)
- Falko Fend
- Institute of Pathology and Neuropathology and Comprehensive Cancer Centre, Tübingen University Hospital, Tübingen, Germany
| | - Andrés J M Ferreri
- Department of Onco-Hematology, Unit of Lymphoid Malignancies, Division of Onco-Hematological Medicine, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Sarah E Coupland
- Department of Cellular and Molecular Pathology, University of Liverpool, Liverpool, England
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Abstract
BACKGROUND The prognosis for patients with primary vitreoretinal is dismal. The close association of primary vitreoretinal lymphoma with primary central nervous system lymphoma is responsible for high rates of mortality. Traditional treatments consist of systemic chemotherapy and whole-brain radiotherapy. The optimal approach for the treatment of isolated primary vitreoretinal lymphoma is unclear. METHODS A review of the relevant medical and scientific literature was performed, focusing on the clinical features of primary vitreoretinal lymphoma and the progress made in the management of isolated ocular disease. RESULTS Ocular treatment options for primary vitreoretinal lymphoma have recently expanded with the addition of intravitreal chemotherapeutic agents and localized radiation. Based on several retrospective reports, a general shift has been made toward local therapy (eg, orbital radiotherapy, intravitreal chemotherapy) for ocular disease. No prospective, randomized clinical trials yet exist to guide therapy. CONCLUSIONS Optimal treatment regimens for isolated primary vitreoretinal lymphoma continue to evolve. Further investigations into novel therapies and protocols are needed to decrease recurrence rates, reduce or prevent central nervous system involvement, and improve rates of overall survival.
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Stübiger N, Kakkassery V, Gundlach E, Winterhalter S, Pleyer U. [Diagnostics and treatment of primary vitreoretinal lymphoma]. Ophthalmologe 2016; 112:223-30. [PMID: 25698590 DOI: 10.1007/s00347-014-3204-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Primary vitreoretinal lymphoma (PVRL) is a rare ocular lymphoid malignancy, mostly a diffuse large B-cell lymphoma. The PVRL, previously called primary intraocular lymphoma (PIOL), is a subset of primary central nervous system lymphoma (PCNSL). DIAGNOSIS The diagnosis of PVRL is often difficult as it often mimics chronic intermediate or posterior uveitis; therefore, PVRL requires various procedures for the diagnostics, e.g. immunohistochemistry, cytology, pathology, molecular pathology and cytokine analysis (interleukin 10) after surgically obtaining ocular specimens. THERAPY Treatment forms that are effective for systemic lymphomas have not been reliably successful for PVRL and PCNSL. Current management of PVRL consists of chemotherapy, such as methotrexate or rituximab, possibly combined with external beam radiation whereby both chemotherapeutic agents are administered systemically as well as intravitreally. Intravitreal treatment alone is recommended solely in the case of monocular PVRL, which is highly controversial. A PVRL usually responds well to initial treatment; however, relapse rates and CNS involvement are high, resulting in a poor prognosis and limited survival.
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Affiliation(s)
- N Stübiger
- Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland,
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Cheah CY, Milgrom S, Chihara D, Gombos DS, Pinnix CC, Dabaja BS, Fowler NH. Intensive chemoimmunotherapy and bilateral globe irradiation as initial therapy for primary intraocular lymphoma. Neuro Oncol 2015; 18:575-81. [PMID: 26487691 DOI: 10.1093/neuonc/nov253] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 09/13/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Primary intraocular lymphoma is a rare variant of primary CNS lymphoma for which the optimum treatment strategy remains unknown. METHODS We performed a retrospective single-center study including patients who underwent uniform management from October 2007 in which patients were offered sequential rituximab, methotrexate, procarbazine, and vincristine (R-MPV) followed by binocular radiotherapy and consolidative high-dose cytarabine. RESULTS Eleven patients with median age 66 years (range, 48-72) were included. All patients received binocular radiotherapy to a median dose of 36 Gy (range, 30.6-39.6) in 20 fractions. Grade 3+ anemia, thrombocytopenia, and neutropenia occurred in 1 (9%), 2 (18%), and 3 (27%) patients, respectively; raised creatinine and peripheral sensory neuropathy occurred in 4 (36%) and 3 (27%) patients, respectively. Grade 3+ ocular toxicities included cataract formation and keratitis in 6 (54%) and 3 (27%) patients, respectively. Ten patients (91%) achieved complete response and 1 (9%) partial response. After median follow-up of 4.2 years (range, 1.8-7.6), the median progression-free survival was 3.8 years and the estimated 4-year overall survival was 75.8% (95% CI: 30.5%-93.7%). The initial site of disease progression was the CNS in 4 of 7 patients (57%) and within the eye in 3 of 7 (43%). Five patients achieved responses to salvage therapies. CONCLUSIONS Combined modality treatment with R-MPV, binocular radiation, and high-dose cytarabine is effective with moderate toxicity. Both local and CNS relapses occur; however, the achievement of second and subsequent remissions is possible.
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Affiliation(s)
- Chan Yoon Cheah
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas (C.Y.C., D.C., N.H.F.); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.M., C.C.P., B.S.D.); Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.S.G.)
| | - Sarah Milgrom
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas (C.Y.C., D.C., N.H.F.); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.M., C.C.P., B.S.D.); Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.S.G.)
| | - Dai Chihara
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas (C.Y.C., D.C., N.H.F.); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.M., C.C.P., B.S.D.); Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.S.G.)
| | - Dan S Gombos
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas (C.Y.C., D.C., N.H.F.); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.M., C.C.P., B.S.D.); Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.S.G.)
| | - Chelsea C Pinnix
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas (C.Y.C., D.C., N.H.F.); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.M., C.C.P., B.S.D.); Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.S.G.)
| | - Bouthaina S Dabaja
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas (C.Y.C., D.C., N.H.F.); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.M., C.C.P., B.S.D.); Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.S.G.)
| | - Nathan H Fowler
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas (C.Y.C., D.C., N.H.F.); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.M., C.C.P., B.S.D.); Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.S.G.)
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Citterio G, Reni M, Ferreri AJM. Present and future treatment options for primary CNS lymphoma. Expert Opin Pharmacother 2015; 16:2569-79. [DOI: 10.1517/14656566.2015.1088828] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Larkin KL, Saboo US, Comer GM, Forooghian F, Mackensen F, Merrill P, Sen HN, Singh A, Essex RW, Lake S, Lim LL, Vasconcelos-Santos DV, Foster CS, Wilson DJ, Smith JR. Use of intravitreal rituximab for treatment of vitreoretinal lymphoma. Br J Ophthalmol 2013; 98:99-103. [DOI: 10.1136/bjophthalmol-2013-304043] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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