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 fundus autofluorescence (FAF) in monitoring response to intravitreal methotrexate (MTX) treatment for patients with primary vitreoretinal lymphoma (PVRL). Methods: All patients treated with intravitreal MTX from the period of January 2016 to December 2017 were reviewed for visual acuity (VA), treatment regimen, side-effects, response, biweekly OCT, and FAF features before and after injections. Results: Patient 1 was a 65-year-old male with high-grade B cell lymphoma. His VA was counting fi ngers, 0.05 and 1/15 at presentation, 1-week and 3-month follow-up respectively. OCT showed Intraretinal hyper-refl ective spots above RPE with rim of SRF, which reduced after 1st week, and IS/OS disruption occurred after 2 months. Patient 2 was a 69-yearold male with NK/T cell lymphoma. He had bilateral intravitreal MTX treatment and had side-effects of corneal toxicity after 4th weekly injection. His VA was 0.1, 0.2 bilaterally, R 0.1 / L 0.4 at presentation, 1-week and 3-month follow-up respectively. OCT showed bilateral rippling of RPE layers with disruption between retinal layers which resolved after 2 weeks of commencing treatment. Patient 3 was a 57-year-old male with negative histology. His VA was 0.1, 0.3, 0.4 at presentation, 1-week and 3-month follow-up respectively. OCT showed peripapillary thickening of RPE and subretinal hyper refl ective material which improved after 2 weeks of treatment, and resolved after 5 weeks of injection. Conclusions: Due to the multiple side-effects of the disease and treatment, response may not be reflected with VA and clinical activity alone. OCT and FAF features are useful in the diagnosis and assessment of response in intravitreal MTX for PVRL.