J Korean Ophthalmol Soc.  2017 Dec;58(12):1410-1415. 10.3341/jkos.2017.58.12.1410.

A Case of Mucosa-associated Lymphoid Tissue Lymphoma Discovered by Repetitive Intraocular Lens Dislocation

• Kim BR
• Choi S
• Seo Y
• Kim TI
• Kim EK
• Yoon JS

• KMID: 2397856
• DOI: http://doi.org/10.3341/jkos.2017.58.12.1410

Abstract

PURPOSE
To report a case where bilateral malignant retrobulbar lymphoma was diagnosed after repetitive intraocular lens dislocation to the anterior chamber.
CASE SUMMARY
An 85-year-old male with a history of stroke who had undergone cataract surgery 10 years ago at another hospital presented with repeated intraocular lens (IOL) dislocations of both eyes into the anterior chamber. He had previously undergone IOL scleral fixation once in his left eye and twice in his right eye, but IOL dislocation was still repeatedly occurring. The best-corrected visual acuity was 0.4 in both eyes. Hertel exophthalmetry was 20 mm in his right eye and 18 mm in his left eye. Painless limitation of motion at supraduction was observed in the right eye. Funduscopy showed newly appeared choroidal folding in the right eye, so orbital computed tomography (CT) with contrast was performed. The CT scans showed bilateral homogenously enhancing retrobulbar masses. Biopsy of the masses showed a MALToma. After radiation therapy, the choroidal folds resolved and exophthalmetry improved to 10 mm in both eyes. No additional IOL dislocation occurred. During 2.5 years of follow-up, there was no evidence of recurrence or distant metastasis of the MALToma.
CONCLUSIONS
Orbital lymphomas can cause lid edema, exophthalmos, strabismus, and diplopia, and can be diagnosed with imaging modalities such as CT. Final diagnosis involves biopsy and radiation therapy or chemotherapy. If IOL dislocation occurs repeatedly, it may result from an increase in retrobulbar pressure, and concurrent choroidal folding using funduscopy is strongly recommended for imaging to check for the presence of retrobulbar masses.

Keyword

Choroidal folds; Dislocation of intraocular lens; Retrobulbar mass; MALToma

MeSH Terms

Aged, 80 and over
Anterior Chamber
Biopsy
Cataract
Choroid
Diagnosis
Diplopia
Dislocations*
Drug Therapy
Edema
Exophthalmos
Follow-Up Studies
Humans
Lenses, Intraocular*
Lymphoma
Lymphoma, B-Cell, Marginal Zone*
Male
Neoplasm Metastasis
Orbit
Recurrence
Strabismus
Stroke
Tomography, X-Ray Computed
Visual Acuity

Figure

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  Figure 1 The picture shows the ocular movement of the patient. Limitations of motion in the right eye at all gazes are noted. Also, the patient experienced diplopia at all gaze.

• 

  Figure 2 The patient's fundus photographs. (A) Choroidal folds shown on fundus photograph. (B) After radiation therapy, the choroidal folding resolved and the fundus had a normal appearance.

• 

  Figure 3 The patient's computed tomography (CT) images. (A) The axial and coronal views of the CT show approximately 3.6 cm sized homogeneously enhancing mass in the right interconal space encasing the optic nerve. Another 2.5 cm sized enhancing mass is shown in the left extraconal space with superior rectus muscle involvement. It suggests orbital lymphoma, bilateral. (B) The axial and coronal views of the CT 6 months after radiation therapy. The picture shows decreased mass size of the right orbital mass and no residual mass in the left orbit.

• 

  Figure 4 Immunohistopathological characteristics of the mass. It is consistent with extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). (A) Tumor cells are negative for CD3 (×200), (B) positive for CD20 antigen (×200) and (C) negative for Cyclin D1 (×200). (D) Small lymphoid cell proliferation was easy to be observed (Hematoxylin and eosin stain, ×200).

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