Clinical Features and Treatment Outcomes of Vitreoretinal Lymphoma according to Its Association with CNS Lymphoma

Cho, Bum-Joo; Kim, Dong Yoon; Park, Un Chul; Lee, Joo Yong; Yoon, Young Hee; Yu, Hyeong Gon

doi:10.1080/09273948.2017.1421669

Cited by 43 publications

(45 citation statements)

References 21 publications

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“…These findings confirmed that diagnosis of VRL remains a challenge for clinicians. A recent report by Cho et al showed a significantly shorter diagnostic delay among patients with secondary VRL when compared with PVRL, but these data have not been confirmed in our series.…”

Section: Discussioncontrasting

confidence: 99%

“…Data from literature is conflicting with some reports suggesting a worse survival in patients with concurrent VRL and CNS lymphoma, while others reporting poorer outcome in primary CNS disease without concurrent intraocular involvement. A large cooperative study of 221 patients with CNS lymphoma with ocular involvement demonstrated similar OS when compared with primary CNS lymphoma without VR involvement .…”

Section: Discussionmentioning

confidence: 90%

“…In selected cases, vitrectomy or ocular enucleation could be considered for a better local control of recurrent and chemoresistant diseases . Some studies failed to find significant differences in CNS‐relapse incidence and survival between different types of treatment, leaning to a local approach with less toxicities . Other reports suggest that a systemic or combined approach might prolong CNS‐relapse free survival (RFS), with a tolerable safety profile .…”

Section: Introductionmentioning

confidence: 99%

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Role of systemic high‐dose methotrexate and combined approaches in the management of vitreoretinal lymphoma: A single center experience 1990‐2018

et al. 2018

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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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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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Role of systemic high‐dose methotrexate and combined approaches in the management of vitreoretinal lymphoma: A single center experience 1990‐2018

et al. 2018

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“…Subsequent to the original clinical case series, medical centres in North America, Europe, the Middle East and Asia also have reported their experience in treating groups totalling at least 177 eyes of 114 patients with VRL, [34][35][36][37][38][39][40] as well as multiple individual patients, [41][42][43][44][45] using intravitreal methotrexate injections. Additional reports have described groups of patients suffering from VRL, who received a range of treatments that included methotrexate and/or rituximab intravitreal injections (see below).…”

Section: Intraocular Methotrexate Therapymentioning

confidence: 99%

Intraocular chemotherapy for vitreoretinal lymphoma: A review

Kvopka

Lake

Smith

2019

Clinical Exper Ophthalmology

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Vitreoretinal lymphomas are rare ocular cancers, and the subset of primary central nervous system lymphomas that are based in the posterior eye. These tumours are challenging to treat, and today management generally involves a multispecialty team coordinating a treatment protocol that may include intraocular chemotherapy, ocular irradiation, systemic chemotherapy and/or autologous stem cell transplantation. The ophthalmologist has specific responsibility for the intraocular chemotherapy, which is delivered to the eye by intravitreal injection. The most commonly injected drugs are methotrexate—an anti‐metabolite—and rituximab—an anti‐human B cell monoclonal antibody. A range of intraocular chemotherapy treatment schedules have been described in the medical literature, although to date there have been no randomized clinical trials of these schedules. In this article, we review the development and current status of intraocular chemotherapy for vitreoretinal lymphoma.

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“…Intraocular lymphomas are important causes of masquerades because they can present with protean manifestations, such as vitritis, retinal vasculitis, hypopyon uveitis, or even macular edema. [138][139][140] Fardeau et al compared the clinical, angiographic, and tomographic characteristics of 244 consecutive patients with severe posterior uveitis who underwent vitreous biopsy for cytological analysis. The authors obtained 53 positive samples for intraocular lymphoma (non-Hodgkin's type) and 191 without any tumor cells.…”

Section: Tumoral Macular Edemamentioning

confidence: 99%

Disease of the Year: Differential Diagnosis of Uveitic Macular Edema

Agarwal

Pichi

Invernizzi

et al. 2018

Ocular Immunology and Inflammation

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Uveitic cystoid macular edema (UME) is an important cause of visual morbidity among patients with both infectious and non-infectious uveitis. UME may be associated in more than 30% cases of active uveitis. However, even patients with minimal features of intraocular inflammation may develop recurrent or chronic UME. Therefore, the evaluation and management of UME in patients with uveitis may be challenging. A number of vitreoretinal pathologies may result in UME and accumulation of fluid in the intra-or subretinal space. These need to be carefully distinguished from each other so that appropriate management can be initiated. All types of uveitis, including anterior uveitis (where the primary site of inflammation is not in the posterior segment) can present with UME. Other conditions such as diabetes, and surgery, can present with macular edema. This index review highlights various differential diagnoses of UME and provides illustrative case examples with multimodal imaging evaluation.

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Clinical Features and Treatment Outcomes of Vitreoretinal Lymphoma according to Its Association with CNS Lymphoma

Abstract: Ocular presentation and survival times may be different in VRL patients according to the association with CNS involvement.

Cited by 43 publications

References 21 publications

Role of systemic high‐dose methotrexate and combined approaches in the management of vitreoretinal lymphoma: A single center experience 1990‐2018

Role of systemic high‐dose methotrexate and combined approaches in the management of vitreoretinal lymphoma: A single center experience 1990‐2018

Intraocular chemotherapy for vitreoretinal lymphoma: A review

Disease of the Year: Differential Diagnosis of Uveitic Macular Edema

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