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Intraocular Lymphoma
Manfred Zierhut
Centre of Ophthalmology
University of Tuebingen,
Germany
Ocular History
 46 year old woman
 3-2000: OD blurred vision
 1999: OS „similar problems“
April 2000: First Presentation
 VA: OD 20/20, OS 20/25
 Mild AC cell infiltration
 Fundus:
 Multifocal chorioretinitis
 Pigment atrophy
April 2000: First Presentation
 ESR: 59/100 (known since 1995)
 Prednisolone 75 mg
 Improvement
June 2000 to February 2001
 6-2000: Recurrence with retinal infiltration
 8-2000:
 OD: CME: VA 20/32
 Prednisolone: minimal improvement
 9-2000: Optic disc edema with bleeding
 11-2000: Azathioprine 150 mg
 2-2001: inactive, VA 20/20
May 2001
 Peripheral CNV with
subretinal bleeding
 Serpiginous chorioretinitis?
July 2001 to August 2001
 7-2001:
 Pigmentepithel detachment
 Exsudative retinal detachment
 MRI of the brain: negative
 Steroid induced diabetes
 8-2001:
 Cyclosporine A: bleeding in resorption
September to October 2001
 9-2001:
 OD: 20/100, OS: 20/32
 Massive vitreous cells
 10-2001:
 OD: 20/400
 Diagnostic ppV: no lymphoma cells
Diagnosis after choroidal Biopsy
 B-cell non-Hodgkin lymphoma
 Positive for CD20, MIB1
 Negative for CD3, CD138, c-kit,
HMB45, κ-, and λ
 Bone marrow: negative
Problems
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Ocular disease with the highest 5-year letality
Increasing incidence
Diagnosis often late
Negative vitreous biopsy does not exclude NHL
Therapy not clear when CNS-manifestation is
missing
Case Report:
Treatment
 Intravenous Methotrexate
 10-2001: 1. course (7.52 g)
 11-2001: 2. and 3. course
 12-2001: 4. and 5. course
 1-2002: 6. course
Follow-up
 11-2001:
 VA: 20/200, 20/40
 Remaining bleedings
 Resorption of the infiltration
 Scarring
 10-2007:
 No signs of recurrence or scarring
 VA: 20/200, 20/20
Final Diagnosis
 Non-Hodgkin lymphoma without CNS
involvement
 Untypical clinical manifestation immitating
 Serpigninous
 Multifocal chorioretinitis
 With development of subretinal
neovascularisation membrane
 Good response of the eye to i.v. MTX
Conclusion
 Clinic of intraocular lymphoma highly variable
 Can mimic multiple other uveitis disorders
 When diagnostic ppV negative but still suggestive
for lymphoma: retinal biopsy
 In this patient i.v. MTX (3 g/m2) was effective as
monotherapy