SS-OCT/OCTA Assessment of Choroidal Structure in Vitreoretinal Lymphoma Patients and Their Changes During Intravitreal Methotrexate Chemotherapy.

PURPOSE: To evaluate choroidal structure changes in vitreoretinal lymphoma (VRL) patients during intravitreal methotrexate (MTX) therapy and quantitative characteristics of active VRL at choroidal level using swept-source optical coherence tomography angiography (SS-OCT/OCTA).

METHODS

In this retrospective study, patients diagnosed with VRL and received intravitreal MTX chemotherapy from January 2022 to December 2023 were included, along with healthy volunteers of the same age range and sex ratio. Three-phase intravitreal MTX chemotherapy consisting of induction, consolidation, and maintenance was scheduled. SS-OCT/OCTA images obtained before intraocular chemotherapy and by the end of each phase of treatment were reviewed. Choroidal thickness (CT), choriocapillaris (CC) perfusion area, choroidal vessel volume (CVV), choroidal vascularity index (CVI), and choroidal stromal volume (CSV) were analyzed.

RESULTS

Forty-four eyes of 29 VRL patients (15 males, 14 females) were enrolled in this study. CT, CVV, and CSV decreased significantly by the end of induction phase and maintained a continuous decrease during intravitreal MTX chemotherapy (all P < 0.05), whereas CC perfusion area and CVI remained statistically comparable. Comparative analysis demonstrated significantly lower CVI in VRL eyes versus normal controls across all measured regions (all P < 0.05), whereas CT, CVV, and CSV showed no intergroup differences.

CONCLUSIONS

VRL eyes demonstrated a decreased CVI, which reflected lymphoma-induced structural changes at the choroidal level. After intravitreal MTX treatment, CT, CVV, and CSV all showed a significant reduction.

TRANSLATIONAL RELEVANCE: SS-OCT/OCTA-derived choroidal parameters (CT, CC perfusion area, CVI, CVV, and CSV) enable noninvasive monitoring of choroidal changes in VRL patients.