Dear Editor,
We have read with interest the paper by Klimova et al. Some statements in the paper are confusing and may even mislead the readers.
The authors claim in the survival section of the paper that: "Vitreoretinal lymphoma is a life-threatening disease, with a 5-year survival rate of 71% in our study". Vitreoretinal lymphoma (VRL) may affect vision, and in very advanced cases that we rarely see in recent years, may destroy the eye. However, VRL per se is not what that kills the patients, but the associated brain lymphoma or in some case the systemic lymphoma.
According to the results in this study (and the title of the paper), "Combined (local and systemic) treatment in patients with PVRL showed favorable results in comparison with local therapy alone (p=0.695). However, the statistical significance was not reached". It is no wonder that they claim that combined treatment is better than local treatment when they have 60% relapses. However, no other study of intra-vitreal (IVit) Methotrexate showed such a high relapse rate. In our experience, the relapse rate is extremely low with IVit methotrexate alone. Actually, in summarizing our ten years results we had no recurrence of the intraocular disease (2) and summarizing now our 20-year experience with 113 eyes, we had only two cases of recurrences (unpublished data). It is difficult to explain the poor results of the authors’ patients, using either intravitreal methotrexate alone or in combination with systemic high dose methotrexate.
In their discussion, the authors write that "Vitreoretinal lymphomas are considered to be systemic disease….". It should be emphasized that this disease is in most cases a unique type of lymphoma that affects immune-privileged organs: the brain, the eye, and the testis, and only in some cases (17% in our experience), the eye disease accompanies systemic lymphoma.
References
1) Klimova A, Heissigerova J, Rihova E, et al. Combined treatment of primary vitreoretinal lymphomas significantly prolongs the time to first relapse. Br J Ophthalmol 2018, doi: 10.1136/bjophthalmol-2017-311574
2) Frenkel S, Hendler K, Siegal T, et al. Intravitreal methotrexate for treating vitreoretinal lymphoma: 10 years of experience. Br J Ophthalmol 2008;92:383-8.
Sincerely Yours,
Jacob Pe'er, M.D.
Shahar Frenkel, M.D., Ph.D.
Ocular Oncology Service
Department of Ophthalmology
Hadassah – Hebrew University Medical center
Jerusalem, Israel
Dear Editor,
We have read with interest the paper by Klimova et al. Some statements in the paper are confusing and may even mislead the readers.
The authors claim in the survival section of the paper that: "Vitreoretinal lymphoma is a life-threatening disease, with a 5-year survival rate of 71% in our study". Vitreoretinal lymphoma (VRL) may affect vision, and in very advanced cases that we rarely see in recent years, may destroy the eye. However, VRL per se is not what that kills the patients, but the associated brain lymphoma or in some case the systemic lymphoma.
According to the results in this study (and the title of the paper), "Combined (local and systemic) treatment in patients with PVRL showed favorable results in comparison with local therapy alone (p=0.695). However, the statistical significance was not reached". It is no wonder that they claim that combined treatment is better than local treatment when they have 60% relapses. However, no other study of intra-vitreal (IVit) Methotrexate showed such a high relapse rate. In our experience, the relapse rate is extremely low with IVit methotrexate alone. Actually, in summarizing our ten years results we had no recurrence of the intraocular disease (2) and summarizing now our 20-year experience with 113 eyes, we had only two cases of recurrences (unpublished data). It is difficult to explain the poor results of the authors’ patients, using either intravitreal methotrexate alone or in combination with systemic high dose methotrexate.
In their discussion, the authors write that "Vitreoretinal lymphomas are considered to be systemic disease….". It should be emphasized that this disease is in most cases a unique type of lymphoma that affects immune-privileged organs: the brain, the eye, and the testis, and only in some cases (17% in our experience), the eye disease accompanies systemic lymphoma.
References
1) Klimova A, Heissigerova J, Rihova E, et al. Combined treatment of primary vitreoretinal lymphomas significantly prolongs the time to first relapse. Br J Ophthalmol 2018, doi: 10.1136/bjophthalmol-2017-311574
2) Frenkel S, Hendler K, Siegal T, et al. Intravitreal methotrexate for treating vitreoretinal lymphoma: 10 years of experience. Br J Ophthalmol 2008;92:383-8.
Sincerely Yours,
Jacob Pe'er, M.D.
Shahar Frenkel, M.D., Ph.D.
Ocular Oncology Service
Department of Ophthalmology
Hadassah – Hebrew University Medical center
Jerusalem, Israel