J Korean Ophthalmol Soc.  2009 Jan;50(1):78-84. 10.3341/jkos.2009.50.1.78.

Clinical Manifestations of Intraocular Lymphoma

• Suh MH
• Yu HG

• KMID: 2211900
• DOI: http://doi.org/10.3341/jkos.2009.50.1.78

Abstract

PURPOSE
To investigate the clinical features and prognosis of primary intraocular lymphoma (PIOL).
METHODS
A retrospective review of medical records was performed in 9 patients who were diagnosed and treated as PIOL in the Department of Ophthalmology, Seoul National University Hospital.
RESULTS
Among patients who were enrolled in the study, 14 eyes were examined. Thirteen eyes (92.9%) showed yellowish subretinal or choroidal infiltrates which is a characteristic finding of PIOL in fundus examination and fluorescein angiography. Three patients presented with ocular symptoms initially, and 5 patients later presented with central nerve system (CNS) involvement. Only 1 patient showed PIOL without CNS involvement. Among 6 patients (9 eyes) that received systemic chemotherapy or ocular irradiation, 5 patients (7 eyes, 77.8%) responded. Among those patients, 3 patients (4 eyes) showed relapse of PIOL. Five patients died during the mean follow-up period of 43.3 months, and the median survival time was 47 months.
CONCLUSIONS
The most common characteristic fundus finding of PIOL is subretinal or choroidal infiltration. Ocular irradiation combined with systemic chemotherapy is the first method of treatment, although long-term prognosis is poor.

Keyword

Primary central nervous system lymphoma; Primary intraocular lymphoma; Prognosis; Subretinal or choroidal infiltration; Vitreous biopsy

MeSH Terms

Choroid
Eye
Fluorescein Angiography
Follow-Up Studies
Humans
Lymphoma
Medical Records
Ophthalmology
Prognosis
Recurrence
Retrospective Studies

Figure

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  Figure 1. Case 1. Right eye. Dense sheet-like vitreal infiltration.

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  Figure 2. Multiple dots of yellowish chorioretinal infiltration (A) and multiple hypofluoresecent dots intermingling with hyperfluorescent dots at the level of the retinal pigment epithelium, suggestive of an aggregate of tumor cells at fluorescein angiogram (B).

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  Figure 3. Pretreatment fundus photograph demonstrates large infiltrative subretinal mass involving inferior retina and diffuse vitreous infiltration (A). Subretinal mass and vitreous infiltrationdisappeared 4 months after combined chemo-radiation therapy, and atrophy of optic disc and retina remained as a sequaele (B).

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  Figure 4. Case 1 right eye. Wright-Giemsa stain of vitreous specimen shows immature pleomorphic lymphocytes with microcystic nucleus and ill-defined nucleus membrane (black arrows). Nectrotic atypical lymphocytes cells were also found (red arrows)(×200).

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  Figure 5. Kaplan-Meier Survival curve for overall survival (median 43.3 months).

Reference

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