Objective:

To analyze the dynamic interplay of vitreous immune mediators during intravitreal methotrexate and dexamethasone therapy in a patient with vitreoretinal lymphoma, highlighting its significance in understanding VRL.

Key Findings:

• Key cytokines IL-10, IL-6, IL-16, IL-1RA, and sIL-2R decreased progressively, with IL-10 becoming undetectable by day 22, indicating a potential response to therapy.
• Chemokines CXCL12 and CXCL13 declined more slowly, suggesting persistent support for tumor cells, which may influence treatment strategies.
• MCP-1 remained elevated, while hepatocyte growth factor (HGF) was consistently high, indicating potentially aggressive behavior and the need for close monitoring.
• Certain cytokines previously reported in VRL cohorts were not elevated, indicating patient-specific variability that could inform personalized treatment approaches.

Interpretation:

Dynamic changes in soluble mediators mirrored clinical tumor regression and suggested potential biomarkers for disease activity and therapeutic response, which could guide future treatment decisions.

Limitations:

• Observations are based on a single case and require confirmation in larger cohorts to validate the findings and address potential biases.

Conclusion:

The study proposes a novel framework for integrating intraocular immunomonitoring into personalized therapeutic strategies and enhances understanding of the tumor–immune microenvironment in vitreoretinal lymphoma, emphasizing the need for further studies.