Using optical coherence tomography and autofluorescence to monitor treatment response of intravitreal methotrexate for primary vitreoretinal lymphoma

Abstract

PURPOSE: To describe the use of Optical Coherence Tomography (OCT) and Autofluorescence (FAF) in monitoring response to Intravitreal Methotrexate (MTX) treatment for patients with Primary Vitreoretinal Lymphoma (PVRL) SETTING: Single centre, Primary government hospital in Hong Kong METHODS: All consecutive patients treated with intravitreal injection of MTX from the period of Jan 2016 to Dec 2017 were reviewed for diagnosis, visual acuity, treatment regimen, treatment side effects, treatment response, biweekly OCT, and FAF features before and after injections RESULTS: Patient 1, Male, age 65 (high grade B cell lymphoma). Left eye Intravitreal MTX Treatment weekly x3, two weekly x 2, monthly currently. Visual acuity counting fingers, 0.05, 1/15 at presentation, 1 week and 3 months follow up. OCT showed Intraretinal hyper reflective spots above RPE with rim of SRF reduced after 1st week, IS/OS disruption occurred after 2 months. Patient 2. Male, aged 69 (NK/T cell lymphoma). Bilateral Intravitreal MTX treatment, weekly x4, two weekly x 9. Side effects of corneal toxicity after 4th weekly injection. Visual acuity 0.1 bilaterally, 0.2 bilaterally, R 0.1 / L 0.4 at presentation, 1 week and 3 months follow up. OCT showed bilateral rippling of retinal pigment epithelium layers with disruption between retinal layers which resolved after 2 weeks of commencing treatment. Patient 3. Male, aged 57 (negative histology). Bilateral intravitreal MTX treatment, weekly x 3, every 2 weeks x 4, monthly x 1 year. Visual acuity 0.1, 0.3, 0.4 at presentation, 1 week and 3 months follow up. OCT showed peripapillary thickening of RPE and subretinal hyper reflective material which improved after 2 weeks of treatment and resolved after 5 weeks of injection. Treatment limited by corneal toxicity during weekly treatments. CONCLUSIONS: Due to the multiple side effects of the disease and treatment, including glaucoma, corneal toxicity, vitritis, retinal infiltrates, and cataracts, the treatment response may not be accurately reflected with visual acuity and clinical activity alone. OCT and FAF features are useful in diagnosis and assessment of treatment response in patients undergoing intravitreal MTX for PVRL.