Supplementary Material for: Electrophysiological Monitoring of Focal and Entire Retinal Function during Treatment with Intravitreal Methotrexate for Intraocular Lymphoma

We describe the electroretinographic findings of a case of primary intraocular lymphoma (PIOL) wherein the patient received intravitreal injections of methotrexate (ivMTX). A 62-year-old man developed blurred vision and complained of decreased visual acuity (VA) in his right eye. Fundus examination showed vitreous opacity and multiple subretinal yellowish lesions. Optical coherence tomography (OCT) revealed subretinal and intraretinal infiltrations. The full-field electroretinogram (ffERG) showed subnormal combined rod-cone response and multifocal electroretinogram (mfERG) recorded using skin electrodes showed severe attenuation of the response compared with the other eye. Pars prana vitrectomy, phacoemulsification, and lens implantation were performed to remove the opacity, and vitreous biopsy revealed a high ratio of interleukin 10–6 (76.0). There was no systemic malignant lesion, and the patient was diagnosed with PIOL. Treatment with ivMTX (400 μg/0.1 mL) was started. One month later, the intraretinal infiltration had disappeared, and mfERG revealed recovery of the response density from the central area. Two months later, OCT showed recovery of the foveal ellipsoid and interdigitation zones, and VA recovered to 20/17; mfERG showed maintenance of macular function. However, the amplitude of a- and b-waves in the ffERG gradually decreased. Macular function recovered, but there was also a decrease in total retinal function. mfERG and ffERG recorded using skin electrodes were useful in monitoring macular and entire retinal function with repeated examinations and showed recovery and maintenance of macular function in a case of PIOL treated with ivMTX.

本研究描述了1例原发性眼内淋巴瘤（primary intraocular lymphoma, PIOL）患者接受玻璃体内注射甲氨蝶呤（intravitreal methotrexate, ivMTX）后的视网膜电图检查结果。患者为62岁男性，出现视物模糊，主诉右眼视力（visual acuity, VA）下降。眼底检查可见玻璃体混浊及多发视网膜下黄色病灶，光学相干断层扫描（optical coherence tomography, OCT）显示视网膜下及视网膜内存在浸润灶。全视野视网膜电图（full-field electroretinogram, ffERG）检测显示杆-锥联合反应低于正常水平；采用皮肤电极记录的多焦视网膜电图（multifocal electroretinogram, mfERG）显示，患眼反应振幅较对侧眼显著衰减。患者接受经睫状体平坦部玻璃体切割术、超声乳化术及人工晶状体植入术以清除玻璃体混浊，玻璃体活检结果显示白细胞介素10与6的比值为76.0，显著升高。全身检查未发现系统性恶性病变，患者确诊为原发性眼内淋巴瘤，随后开始予以ivMTX（400 μg/0.1 mL）治疗。治疗1个月后，视网膜内浸润灶消失，mfERG显示黄斑中心区反应密度恢复；治疗2个月后，OCT显示黄斑中心凹椭球区与嵌合带恢复，视力提升至20/17，mfERG显示黄斑功能维持稳定。但ffERG的a波与b波振幅逐渐降低。尽管黄斑功能得以恢复，但全视网膜功能仍出现下降。采用皮肤电极记录的mfERG与ffERG可通过多次随访检查分别监测黄斑功能与全视网膜功能，在接受ivMTX治疗的原发性眼内淋巴瘤病例中，可有效反映黄斑功能的恢复与维持情况。