Clinical features and treatment outcomes of intraocular lymphoma:a single-center experience in China

AIM:To investigate the clinical manifestations,diagnostic approaches,treatments,and outcomes of intraocular lymphoma.METHODS:In this retrospective study,16 patients(28 eyes)with intraocular lymphoma were recruited in the Department of Ophthalmology,Peking Union Medical College Hospital,from 2004 to 2019.All patients underwent comprehensive ophthalmic examinations.Vitreous specimens of 13 patients were sent for cytopathology examination and other adjunctive diagnostic procedures.Three patients were diagnosed with intraocular lymphoma according to analysis of the histopathological results of systemic lymphoma by one clinician.Twenty-three eyes were treated with intravitreal administration of methotrexate,4 eyes could not receive ocular treatment due to life-threatening lymphoma,and 1 eye did not require ocular treatment because the fundus lesions regressed after systematic chemotherapy.RESULTS:In 28 eyes,25 eyes were diagnosed with vitreoretinal lymphoma,and 3 eyes were diagnosed with ciliary body lymphoma,all of which were non-Hodgkin diffuse large B cell lymphomas.The final visual acuity improved in 15 eyes(54%),remained unchanged in 5 eyes(18%),and decreased in 8 eyes(29%).Anterior segment inflammation disappeared or reduced in 8 and 5 eyes,respectively;and 15 eyes had no anterior segment reaction.Twenty eyes had mild vitreous opacity,1 eye had mild vitritis,and 7 eyes had pars plana vitrectomy combinedwith silicone oil tamponade.Fundus lesions disappeared in 9 eyes and were relieved in 5 eyes;4 eyes showed no changes,and the remaining 10 eyes’fundus were normal.CONCLUSION:The clinical manifestations of intraocular lymphoma are diverse,and the misdiagnosis rate is high.Cytopathological analysis of vitreous is one of the gold standards for the diagnosis.Immunohistochemistry,gene rearrangement and flow cytometric immunophenotypic analysis can improve the diagnostic rate.Ocular chemotherapy or radiotherapy regimens may preserve visual acuity,and a multidisciplinary team can provide individualized treatment for the patients.

Generating two-dimensional quantum gases with high stability

Quantum gas microscopy has enabled the study on intriguing properties of ultracold atoms in optical lattices.It provides the cutting-edge technology for manipulating quantum many-body systems.In such experiments,atoms have to be prepared into a two-dimensional(2D)system for being resolved by microscopes with limited depth of focus.Here we report an experiment on slicing a single layer of the atoms trapped in a few layers of pancake-shaped optical traps to create a 2D system.This technique is implemented with a microwave“knife”,i.e.,a microwave field with a frequency defined by the resonant condition with the Zeeman-shifted atomic levels related to a gradient magnetic field.It is crucial to keep a stable preparation of the desired layer to create the 2D quantum gas for future experimental applications.To achieve this,the most important point is to provide a gradient magnetic field with low noises and slow drift in combination with a properly optimized microwave pulse.Monitoring the electric current source and the environmental magnetic field,we applied an actively stabilizing circuit and realized a field drift of 0.042(3)mG/hour.This guarantees creating the single layer of atoms with an efficiency of 99.92(3)%while atoms are hardly seen in other layers within 48 hours,satisfying future experimental demands on studying quantum many-body physics.

Vascular endothelial growth factor concentration in vitreous humor of patients with severe proliferative diabetic retinopathy after intravitreal injection of conbercept as an adjunctive therapy for vitrectomy

Background:Proliferative diabetic retinopathy(PDR)is a progressive stage of diabetic retinopathy featured by the formation of neovascular and proliferative membrane.Vascular endothelial growth factor(VEGF)acts as a pivot factor in the development of neovascularization.This study was to investigate the changes of intravitreal VEGF concentrations of severe PDR after intravitreal injection of conbercept(IVC)and its potential advantages to the following vitrectomy.Methods:This was a prospective,interventional,randomized controlled study.Sixty eyes(60 patients)with severe PDR and 20 eyes from 20 patients with rhegmatogenous retinal detachment complicated with proliferative vitreoretinopathy were enrolled in this study.PDR eyes were randomly assigned to three groups by sortation randomization method with 20 eyes in each based on the interval of preoperative IVC(group A:7 days,group B:14 days,group C:non-IVC).Another 20 eyes without diabetes were enrolled as the non-diabetic control group(group D),receiving PPV directly.Vitreous specimens of all 80 patients were collected and evaluated afterwards.The intravitreal VEGF concentration of the four groups,and the total surgical time and the intraoperative bleeding rate of the PDR groups were recorded.Results:The mean intravitreal VEGF concentrations of groups A-D were 66.6±43.3,93.1±52.3,161.4±106.1 and 1.8±1.2 pg/mL,respectively.It increased significantly in PDR patients(groups A,B and C)(P=0.002,<0.001,and<0.001,respectively).PDR patients with preoperative IVC(groups A and B)presented significantly lower VEGF concentrations(P<0.001 and 0.001),intraoperative bleeding rates(P=0.004)and total surgical time(P<0.001,P=0.003)compared with group C.No statistical differences were presented between groups A and B on the three parameters.Conclusion:Seven days and 14 days of preoperative IVC are equally efficient and safe for the vitrectomy of severe PDR patients through decreasing vitreous VEGF concentrations,intraoperative bleeding rate and total surgical times.

A Case of Primary Central Nervous System Lymphoma with Ciliary Body Involvement

INTRODUCTION Primary central nervous system lymphoma （PCNSL） is defined as lymphoma confined to the brain, eye, spinal cord, or leptomeninges. It constitutes approximately 3% of all brain tumors, and 2-3% of all cases of non-Hodgkin lymphoma. Ocular involvement can be detected during clinical staging in about 20% of patients with PCNSL, with primary vitreous retinal lymphoma being the most common subtype. Uveal involvement of PCNSL is uncommon, and PCNSL with ciliary body involvement （CBL）, to the best of our knowledge, has not been reported.

Varicella-zoster virus as a causative agent of acute retinal necrosis in younger patients

Background: Herpes virus is considered to be the pathogen of acute retinal necrosis (ARN) infection. Previous studies have that patients with ARN caused by the varicella-zoster virus (VZV) are often older, and patients with herpes simplex virus (HSV) induced ARN are considerably younger. However, in our clinical work, we find that VZV is also a pathogen in younger ARN patients. We, therefore, aimed to analyze the common etiology of younger ARN patients. Methods: A retrospective analysis was made of 20 eyes (18 patients) diagnosed as having ARN in the Department of Ophthalmology of Peking Union Medical College Hospital from 2014 to 2016. All patients were reviewed for demographic data, clinical course, clinical manifestations, time from onset to initial physician visit, duration of follow-up, visual acuity at both presentation and final visit, and treatment strategies. A paired t test was used to compare visual acuity between the presenting vision and those of final follow-up. Vitreous or aqueous specimens from 18 eyes of 18 patients were analyzed with multiplex polymerase chain reaction (mPCR)/quantitative PCR (qPCR) and xTAG-liquid chip technology (xTAG-LCT) to determine the causative virus of ARN. Results: Final best visual acuity (BCVA) improved significantly from 1.36±0.95 (median 20/400) to 0.95±0.82 (median 20/100)￠=2.714, P = 0.015) after systemic and intravitreal antiviral treatment combined with or without pars plana vitrectomy. PCR and xTAG-LCT results showed four of the five samples in the younger group (32.2±5.2 years) and 12 of the 13 samples in the senior group (53.6±4.9 years) were positive for VZV, and two of the five samples in the younger group were positive for HSV-1. Conclusions: This study demonstrates that VZV is also a common causative virus for ARN in younger patients. Considering this finding, a systemic antiviral treatment protocol should be immediately changed to intravenous ganciclovir when the patient does not respond to acyclovir before determining the causative virus, especially in younger patients.

A Case of Primary Vitreous Retinal Lymphoma

To the Editor： Primary central nervous system lymphoma （PCNSL） is defined as lymphoma confined to the brain, spinal cord, eye, or leptomeninges. Ocular involvement can be detected in about 20% of PCNSL patients with primary vitreous retinal lymphoma （PVRL）, which is generally a high-grade diffuse large B-cell lymphoma, being the most common subtype.