摘要目的 观察玻璃体腔注射甲氨蝶呤(MTX)治疗玻璃体视网膜淋巴瘤(VRL)的疗效和安全性.方法 回顾性非对照病例系列研究.诊断性玻璃体切割手术病理检查确诊为原发性VRL(PVRL)的10例患者以及脑部组织病理检查确诊中枢神经系统淋巴瘤(PCNSL)后经临床检查确诊为VRL的4例患者共计14例26只眼纳入研究.所有患眼均行视力、眼底彩色照相和光相干断层扫描(OCT)检查.视力检查采用Snellen视力表进行.24只眼可记录到视力.其中,视力≥0.1者17只眼,平均视力为0.45±0.20;视力＜0.1者7只眼,为光感～眼前手动.所有患眼可见玻璃体混浊和(或)视网膜下黄白色病灶.OCT检查可见视网膜色素上皮下隆起.所有患眼均按诱导期-巩固期-维持期的眼内化学药物治疗(化疗)方案行单次玻璃体腔注射MTX治疗,4000 μg/ml的MTX注射0.1 ml.26只眼玻璃体腔注射MTX的平均次数为(11.5±6.3)次.完成眼内化疗20只眼,未完成眼内化疗6只眼.完成眼内化疗的20只眼中,经诊断性玻璃体切割手术后玻璃体肿瘤细胞清除8只眼,有肿瘤细胞浸润12只眼.自眼内化疗开始随访2～48个月,随访中位时间18个月.随访期间采用与治疗前相同的设备与方法行相关检查.以常规玻璃体视网膜检查未见肿瘤细胞,眼底彩色照相和OCT检查未见肿瘤病灶或肿瘤病灶已消退为临床缓解.以视力提高或下降2行及以上为视力显著提高或下降,提高或下降小于2行为视力轻度提高或下降.结果 完成眼内化疗的20只眼经玻璃体腔平均注射MTX(3.5±3.6)次后临床缓解.其中眼内化疗前有肿瘤细胞的12只眼经玻璃体腔平均注射MTX(5.8±3.0)次后临床缓解.治疗前视力≥0.1的17只眼,眼内化疗诱导期平均视力为0.36±0.23,治疗结束后平均视力为0.56±0.20.与治疗前比较,眼内化疗诱导期平均视力轻度下降,但差异无统计学意义(t=1.541,P＞0.05);治疗结束后平均视力轻度提高,差异有统计学意义(t=2.639,P＜0.05).治疗前视力＜0.1的7只眼,治疗结束后视力为无光感～0.1.14例患者中,2例患者因脑部病灶进展,分别于确诊PCSNL后42、48个月死亡.完成眼内化疗的20只眼在随访期内均未发生眼内肿瘤复发.结论 完成玻璃体腔注射MTX眼内化疗的VRL患眼经玻璃体腔平均注射(3.5±3.6)次后临床缓解;随访期间未发生肿瘤复发,视力轻度提高.

abstractsObjective To evaluate the safety and efficacy of the intravitreal methotrexate treatment in patients with primary vitreoretinal lymphoma (PVRL).Methods Retrospective non comparative interventional ease series.Fourteen patients (26 eyes) with biopsy-proven PVRL were included in the study.All patients received examination of Snellen chart visual acuity,fundus color photography and optical coherence tomography (OCT).Among the 24 eyes with recordable visual acuity,17 eyes has initial visual acuity ≥ 0.1 (0.45± 0.20) and 7 eyes with initial visual acuity ranged from light perception to hand movement.The vitreous opacities and (or) subretinal yellowish white lesions and retinal pigment epithelium uplift were observed in all eyes.All eyes were treated with intravitreal methotrexate (4000 μg/ml,0.1 ml)injections according to a induction-consolidation-maintenance regimen.For 26 treated eyes,each received an average of (11.5±6.3) injections.Twenty eyes had finished the intraocular chemotherapy,while 6 eyes had not.Eight of 20 eyes were clinically confirmed free of tumor cells by diagnostic vitrectomy,12 eyes were still with tumor cell involvement.The follow-up was ranged from 2 to 48 months,the mean time was 18 months.The examination of BCVA,fundus color photography and OCT were performed.No tumor cell was defined as clinical remission.Visual acuity was scored as improved or declined obviously (improved or declined 2 lines) or mild improved or declined (changed within 2 lines).Results Twenty eyes achieved clinical remission after (3.5± 3.6) injections,12 eyes of 20 eyes with tumor cell involvement before chemotherapy achieved clinical remission after (5.8 ± 3.0) injections.The mean visual acuity of seventeen eyes with initial visual acuity 0.1 in induction phase and at the end of treatment were 0.36 ± 0.23 and 0.56±0.20,respectively.Compared with before treatment,the visual acuity was mild declined in induction phase (t=1.541,P＞0.05),but mild improved at the end of treatment (t=2.639,P＜0.05).The visual acuity at the end of treatment in 7 eyes with initial visual acuity ＜0.1 was ranged from no light perception to 0.1.()f 14 patients,2 patients have been fatal because of brain lesions progression at 42 and 48 months after diagnosis of primary central nervous system lymphoma.No ocular recurrence was noted during the follow-up in 20 eyes who finished intraocular chemotherapy.Conclusions PVRL patients can achieve clinical remission after (3.5 ±3.6) injections by intravitreal chemotherapy of methotrexate,and the visual acuity improved mildly.No ocular recurrence was found during follow-up.