玻璃体腔注射化学药物治疗玻璃体视网膜淋巴瘤的研究现状与进展

Current state and progress of intravitreal injection of chemotherapeutic agents for the treatment of vitreoretinal lymphoma

原发性玻璃体视网膜淋巴瘤(PVRL)是最常见的原发性眼内淋巴瘤类型。目前治疗方案包括眼局部放射治疗(放疗)、全身化学药物治疗(化疗)、眼局部化疗以及联合治疗等,不同阶段的治疗方案不同,但尚无统一的治疗指南。眼局部化疗可使药物在眼内达到有效治疗浓度,且可重复多次进行,同时避免了全身用药或放疗带来的不良反应,是缓解眼部症状的理想选择。目前主流的眼局部化疗药为甲氨蝶呤(MTX)和利妥昔单抗(RTX),玻璃体腔注射MTX化疗的基本共识是诱导-巩固-维持治疗模式,但相关研究中有关各个阶段治疗时限和频率不尽相同。玻璃体腔注射RTX的时间间隔范围多变,可从1次/周至1次/数月等。MTX频繁注射引起的角膜上皮病变和RTX治疗后较高的复发率是更换治疗方案的主要原因。对于原发性中枢神经系统淋巴瘤合并PVRL的患者,需和神经科联合治疗挽救生命,眼科治疗缓解眼部症状,提高患者生活质量;而对于单独的PVRL无中枢神经系统累及的患者,眼科治疗需控制眼部症状,且应密切随访以及时发现中枢神经系统的累及。

Primary vitreoretinal lymphoma(PVRL)is one of the most common type of primary intraocular lymphoma.The current treatment options include local ocular radiotherapy(radiotherapy),systemic chemotherapy(chemotherapy),local ocular chemotherapy,and combination therapy.The treatment options are different at different stages of PVRL,however,there is no uniform treatment guideline.Local ocular chemotherapy can make the drug reach effective therapeutic concentration in the eye,and it can be repeated many times.At the same time,it can avoid the adverse reactions caused by systemic medication or radiotherapy.It is an ideal choice for relieving ocular symptoms.At present,the mainstream ocular local chemotherapeutics are methotrexate(MTX)and rituximab(RTX).The basic consensus about the intravitreal injection of MTX(IVM)is the induction-consolidation-maintenance model,however,the time of each stage and frequency of IVM are diverse.The time interval of intravitreal injection of RTX is also variable,ranging from 1 time/week to 1 time/months and so on.Corneal epithelial lesions caused by frequent MTX injections and the higher recurrence rate after RTX treatment are the main reasons for changing the treatment plan.For patients with primary central nervous system lymphoma and PVRL,combined treatment with neurology department is necessary to save patient's lives,ophthalmology treatment relieves ocular symptoms and improves the patient's quality of life.For patients with PVRL alone without central nervous system involvement,ophthalmology treatment is necessary to control patient's eye symptoms,and close follow-up should be followed to find the involvement of the central nervous system in time,and then combined with neurological treatment to save patient’s lives.