On March 30, 2024, the inaugural academic forum of the Ocular Lymphoma Collaboration Group was successfully held in Beijing, hosted by Peking University Health Science Center affiliated Beijing Tongren Hospital, the China Health Science and Technology Promotion Association, Beijing Public Health Science Popularization Association, and the Beijing Chen Jumei Public Welfare Foundation. The event, organized by the Cell Immunotherapy Professional Committee of the China Health Science and Technology Promotion Association, saw active exchanges and lively discussions among renowned domestic and international experts and scholars on the latest developments and hot topics in the diagnosis and treatment of ocular lymphoma. Professor Jianmin Ma, the head of the collaboration group and chairman of the conference from Peking University Health Science Center affiliated Beijing Tongren Hospital, was interviewed by “Oncology Frontier – Hematology Frontier” where he shared insights into the establishment of the Ocular Lymphoma Collaboration Group, research progress on ocular adnexal lymphoma, and treatment strategies.
Oncology Frontier – Hematology Frontier: As the chairperson of this conference, could you please introduce the opportunity or highlights of the establishment of the Ocular Lymphoma Collaboration Group?
Professor Jianmin Ma: The inaugural academic forum of the Ocular Lymphoma Collaboration Group is convened today, marking the establishment of China’s first academic entity dedicated to ocular lymphoma. The formation of the Ocular Lymphoma Collaboration Group stems from several reasons: In recent years, our research on ocular lymphoma has made significant progress. We’ve found that ocular lymphoma has a high incidence rate and poses significant threats, not only affecting intraocular tissues like the vitreous body and retina, leading to vision impairment but also potentially involving the central nervous system due to the neural connections between ocular tissues and the brain. Furthermore, recent studies have revealed that ocular lymphoma can affect not only intraocular tissues but also adnexal structures outside the eyeball, including eyelids, conjunctiva, orbital tissues such as lacrimal glands and extraocular muscles, orbital fat, optic nerve, and orbital wall tissues.
Ocular lymphoma, fundamentally a malignancy, presents a broad spectrum of involvement, lacking distinctive clinical diagnostic markers, thus prone to misdiagnosis and underdiagnosis in clinical practice. Treating ocular lymphoma as an inflammatory condition could lead to significant harm to patients, as inflammatory eye conditions are typically benign, whereas ocular lymphoma can be fatal. Moreover, there’s a lack of widely accepted treatment guidelines and protocols for ocular lymphoma. To enhance the diagnosis and treatment efficacy of ocular lymphoma, and improve patient prognosis, we established the Ocular Lymphoma Collaboration Group and organized its inaugural academic conference.
For this conference, we’ve mobilized medical institutions from over 30 provinces and regions across the country, covering nearly all provinces. Apart from the extensive geographical coverage, we’ve involved various clinical departments, including ophthalmology, hematology, radiology, pathology, laboratory medicine, and PET-CT departments. This comprehensive approach is crucial because lymphoma can manifest not only as an ocular disease but also as a systemic disorder. When lymphoma involves not only ocular tissues but also other organs throughout the body, it’s challenging for ophthalmologists alone to manage it effectively. Therefore, led by Peking University Health Science Center affiliated Beijing Tongren Hospital and collaborating with multiple departments from hospitals nationwide, we’ve established the Ocular Lymphoma Collaboration Group, aiming to elevate the diagnosis and treatment standards of ocular lymphoma to new heights.
Furthermore, we aim to continually analyze and summarize large-sample ocular lymphoma lesions to further refine our diagnostic and treatment protocols. Simultaneously, we hope that the establishment of the Ocular Lymphoma Collaboration Group will serve as an opportunity to conduct systematic research on the etiology, pathogenesis, diagnosis, and treatment of ocular lymphoma, deepening our understanding of this disease. This, indeed, is the purpose and original intention behind establishing the Ocular Lymphoma Collaboration Group.
Oncology Frontier – Hematology Frontier: Could you please introduce the current clinical treatment options for ocular adnexal lymphoma?
Professor Jianmin Ma: The treatment of ocular adnexal lymphoma typically involves a comprehensive approach, including medication, surgery, radiation therapy, chemotherapy, targeted therapy, traditional Chinese medicine, and more. Surgery forms the cornerstone of treating ocular adnexal lymphoma because without surgical intervention, obtaining lesion tissues for pathological examination, and thereby establishing a definitive diagnosis, would be impossible. Different surgical approaches are adopted clinically based on the patient’s specific condition. For instance, if the lymphoma lesion affects the eyelids, we can perform excision via an eyelid incision, followed by pathological examination for diagnosis. However, during excision, it’s crucial to consider the aesthetic aspect, making incisions as inconspicuous as possible and minimizing scar visibility. If the lesion involves the conjunctiva, we can meticulously excise the lesion under a microscope for better visualization and delineation of the excision scope. For lesions affecting extraocular muscles, we may surgically remove the severely affected muscles to obtain lesion samples for pathological examination, preserving the functionality of the remaining muscles to prevent postoperative functional impairment.
Another objective of surgery is tumor debulking, aiming to reduce the tumor volume as much as possible. During surgery, preserving the patient’s ocular function is paramount, minimizing the risk of postoperative complications such as eyelid motility disorders, ptosis, ocular motility impairment, visual acuity decline, or even loss. After surgical excision and pathological diagnosis of ocular adnexal lymphoma, additional treatments such as local radiotherapy and systemic chemotherapy can be administered based on the specific disease presentation, often achieving satisfactory treatment outcomes. In summary, the treatment approach should be tailored based on factors like the patient’s age, extent of lesion involvement, and pathological nature to devise the optimal personalized treatment plan.
Oncology Frontier – Hematology Frontier: What are the common complications of surgical treatment for ocular adnexal lymphoma, and how can they be better prevented and managed?
Professor Jianmin Ma: Unlike common eye conditions, ocular adnexal lymphoma presents a wide range of involvement and diverse clinical manifestations, necessitating highly individualized treatment approaches. As mentioned, surgery forms the basis of ocular adnexal lymphoma treatment. One of the surgical goals is to obtain lesion samples for pathological examination to establish a diagnosis definitively. Another goal is to excise the tumor while preserving the patient’s ocular function as much as possible and reducing tumor volume to facilitate subsequent treatments like radiotherapy and chemotherapy.
Theoretically, any surgical procedure for ocular adnexal lymphoma carries risks. For instance, if the lymphoma affects the eyelids, particularly involving the levator palpebrae superioris, postoperative eyelid elevation dysfunction may occur or worsen, leading to ptosis. If the lymphoma involves extraocular muscles, partial excision of the affected muscles is recommended to obtain lesion samples while preserving most of the muscles’ functionality. However, when the lesion extends deeply into the orbit, especially around the optic nerve, surgical risks must be highly considered. Serious complications such as visual acuity decline or even blindness may occur if severe complications arise, albeit rarely in clinical practice.
Surgical complications include intraoperative and postoperative complications. Bleeding is one of the common intraoperative complications. Preoperative assessment and meticulous surgical techniques are essential to minimize bleeding risks. Postoperatively, hemostatic medications should be administered as necessary, and observation for bleeding should be conducted. Infection postoperatively cannot be ignored, especially in ocular adnexal lymphoma patients with compromised immune systems. Prophylactic antibiotics may be prescribed to prevent infection. Given the extensive involvement of ocular adnexal lymphoma lesions, involving all orbital tissues, surgeons must possess thorough anatomical knowledge of the orbit and its surrounding structures to minimize or avoid surgical complications effectively.
In conclusion, personalized treatment plans should be adopted based on the patient’s specific condition to minimize the occurrence of surgical complications, with prevention being the key focus.
Professor Jianmin Ma is the Director of Ocular Oncology Department at Beijing Tongren Hospital, Capital Medical University. He holds positions as Chief Physician, Professor, and Doctoral Supervisor.
Additional Roles: He serves as the Chairman of the Ocular Oncology Specialty Committee of the Chinese Physicians Association Ophthalmology Branch, Head of the Ocular Oncology Group of the Chinese Association of Chinese and Western Medicine Ophthalmology Specialty Committee, Director of the Ocular Tumor and Orbital Disease Sub-Committee of the Beijing Medical Association Ophthalmology Branch, Leader of the Ophthalmology Professional Group of the Chinese Association of Chinese and Western Medicine, Vice Chairman of the Chinese Association of Rehabilitation Engineering and Assistive Technology Professional Committee, Vice Chairman of the China Population Culture Promotion Association Cancer Patient Care Work Committee, Secretary-General of the Eye Health Branch of the China Elderly Health Care Association, Deputy Secretary-General and Standing Committee Member of the Ophthalmology Branch of the China International Medical Exchange and Promotion Association, Deputy Chairman of the Expert Committee of the Chinese National Health Association Popular Health Science Popularization Branch, Director of the Eye Section, and Editorial Board Member and Review Expert for various journals such as the “Chinese Journal of Ophthalmology,” “Chinese Journal of Experimental Ophthalmology,” “Chinese Journal of Clinical Medicine (Electronic Edition),” “International Ophthalmology Newsletter,” and “Chinese Journal of Ophthalmology (Electronic Edition)”.
Honors and Achievements: He has authored and published over 280 articles, contributed to more than 60 books, including 12 as the chief editor or translator and 13 as associate editor or translator, and participated in six national-level projects as the principal investigator, including five National Natural Science Foundation projects and ten provincial and municipal projects. He has received over 40 awards, including being selected as a Beijing Science and Technology Rising Star in 2004, receiving the “Chinese Ophthalmological Society Award” from the Chinese Medical Association Ophthalmology Branch in 2009, being included in the Beijing Health System’s High-Level Health Technology Talent Training Program in 2011, being named an Outstanding Young Physician in Beijing in 2012, receiving the Fourth Chinese Ophthalmologists Award in 2013, and being awarded the Outstanding Work Award by the Asia-Pacific Academy of Ophthalmology in 2016. He was also selected for the Beijing Health Commission’s “Peak” Talent Training Program in 2019.
Areas of Expertise: Professor Ma specializes in the diagnosis, treatment, and surgery of various challenging ocular tumors and orbital diseases. He particularly excels in treating conditions such as retinoblastoma, inflammatory pseudotumor of the orbit, thyroid-related eye diseases, benign lymphoid epithelial lesions, and adenoid cystic carcinoma of the lacrimal gland.
