The treatment of primary vitreoretinal lymphoma (PVRL) remains controversial regarding the use of local, systemic, or combined treatments. The aim of this study was to analyze the efficacy and toxicity of intravenous high‐dose methotrexate (IV HD‐MTX) based systemic therapy in a uniformly treated population of PVRL patients. From a nationwide French database, we retrospectively selected 59 patients (median age: 70 years, median Karnofsky Performance Status: 90%) with isolated PVRL at diagnosis who received first‐line treatment with HD‐MTX between 2011 and 2018. 8/59 patients also received a local treatment. No deaths or premature discontinuations of MTX due to toxicity were reported. A complete response was obtained in 40/57 patients after chemotherapy. Before treatment, IL‐10 was elevated in the aqueous humor (AH) or in the vitreous in 89% of patients. After treatment, AH IL‐10 was undetectable in 87% of patients with a CR/uCR/PR and detectable in 92% of patients with PD/SD. After a median follow‐up of 61 months, 42/59 (71%) patients had relapsed, including 29 isolated ocular relapses as the first relapse and a total of 22 brain relapses. The median overall survival, progression‐free survival, ocular‐free survival and brain‐free survival were 75, 18, 29 and 73 months, respectively. IV HD‐MTX based systemic therapy as a first‐line treatment for isolated PVRL is feasible, with acceptable toxicity, even in an elderly population. This strategy seems efficient to prevent brain relapse with prolonged overall survival. However, the ocular relapse rate remains high. New approaches are needed to improve local control of this disease, and ocular assessment could be completed by monitoring AH IL‐10.

To evaluate the safety and efficacy of FACi injected 1month after the last DEXi injection in pseudophakic patients without ocular hypertension who required frequent DEXi injections (<6months). This was a prospective study including pseudophakic patients with chronic diabetic macular edema (DME) previously treated with DEXi without secondary ocular hypertension. All patients received DEXi followed by FAci one month later. Visits were scheduled at baseline, M1, then every 3months up to 12months. Fourteen eyes of 11 patients were included and were followed until the 12-month time point. Visual gain was significant at M6 (+5.6 letters) and at M9 (+7.1 letters). A reduction in central macular thickness was obtained at 1 month (-86μm), remaining stable over subsequent visits. The rate of ocular hypertension requiring pressure lowering treatment was 14%. Three eyes needed additional treatment (21%); one eye was treated with aflibercept, and 2 eyes with DEXi at M5 and M11. No patient underwant additional FAc implantation during the 11 months of follow-up. Injection of FAci one month after DEXi in pseudophakic patients with chronic DME who responded previously to DEXi results in anatomical improvement and deferred visual gain. This prospective study demonstrates the efficacy and safety of both implants in DME patients who have been previously treated with other therapies.

Background: In clinical practice, visual outcomes with anti-VEGF therapy may be worse than those observed in clinical trials. In this study, we aim to investigate the long-term outcomes of neovascularization treated with intravitreal aflibercept injections (IAI) in a teaching hospital setting. Methods: This is a retrospective, single-center study including 81 nAMD patients (116 eyes), those both newly diagnosed and switched from ranibizumab. All patients had a follow-up duration of at least seven years. Treatment involved three monthly injections followed by either a pro re nata (PRN) or treat and extend regimen. Follow-up care was primarily conducted by training physicians. The primary endpoint was the change in best-corrected visual acuity (BCVA) over seven years. Secondary endpoints included central retinal thickness changes, qualitative OCT parameters, macular atrophy progression, injection frequency, and treatment adherence. Results: Among the 116 eyes, 52 (44.8%) completed the seven-year follow-up. Visual acuity improved by +2.1 letters in the overall population (+6.3 letters in treatment-naive eyes) after the loading phase but gradually declined, resulting in a loss of −12.3 letters at seven years. BCVA remained stable (a loss of fewer than 15 letters) in 57.7% of eyes. Central retinal thickness (CRT) decreased significantly during follow-up in both naive and switcher eyes. Macular atrophy occurred in 94.2% of eyes, progressing from 1.42 mm² to 8.55 mm² over seven years (p < 0.001). The mean number of injections was 4.1 ± 1.8 during the first year and 3.7 per year thereafter. Advanced age at diagnosis was a risk factor for loss to follow-up, with bilaterality being a protective factor against loss to follow-up (p < 0.05). Conclusions: This study highlights the challenges faced by a retina clinic in a teaching hospital. Suboptimal functional and anatomical outcomes in real life may derive from insufficient patient information and inconsistent monitoring, which contributes to undertreatment and affects long-term visual outcomes. It also raises concerns about supervision in a teaching hospital which needs to be improved.