Ridley M E, McDonald H R, Sternberg P, Blumenkranz M S, Zarbin M A, Schachat A P
Department of Ophthalmology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC.
Ophthalmology. 1992 Jul;99(7):1153-60; discussion 1160-1. doi: 10.1016/s0161-6420(92)31834-2.
Diagnosis and treatment of ocular large cell lymphoma may lessen visual loss and prolong life. Although reports in the literature have described retinal infiltrates in eyes with large cell lymphoma, they have focused on the more prominent vitreous and subretinal pigment epithelial findings. Eyes with retinal infiltrates and hemorrhagic retinal necrosis are usually believed to harbor a microbial infection. The authors describe 5 patients, aged 57 to 85 years, with ocular lymphoma in whom the most prominent initial findings were in the retina.
Patients presented with findings suggestive of an infectious retinal necrosis. When the initial therapy failed, investigators performed a vitreous biopsy. Two patients had a concomitant retinal biopsy. Radiation therapy was given to four patients.
All five patients had vitreous cells. Three patients had prominent perivascular exudate. Four patients had grayish-white retinal infiltrates, and three patients had associated retinal hemorrhage. Three patients had subretinal small white spots. An edematous thickened retina developed in three patients, and hemorrhagic retinal necrosis developed in three patients. The initial diagnosis was believed to be acute retinal necrosis (ARN) in three patients, toxoplasmosis in one patient, and frosted branch angiitis in one patient. Vitreous biopsy was positive in two patients but negative in three patients. In two of these three patients, the diagnosis was established by retinal biopsy.
Ocular lymphoma should be considered in the differential diagnosis of retinal vasculitis or necrotizing retinitis in a middle-aged or older patient. Retinal biopsy may be helpful in establishing the diagnosis.
眼部大细胞淋巴瘤的诊断与治疗可能会减少视力丧失并延长生存期。尽管文献报道描述了大细胞淋巴瘤患者眼部的视网膜浸润情况，但这些报道主要关注更为突出的玻璃体和视网膜色素上皮下表现。视网膜有浸润及出血性视网膜坏死的眼睛通常被认为存在微生物感染。作者描述了5例年龄在57至85岁之间的眼部淋巴瘤患者，其最初最突出的表现位于视网膜。
患者表现出提示感染性视网膜坏死的症状。初始治疗失败后，研究人员进行了玻璃体活检。2例患者同时进行了视网膜活检。4例患者接受了放射治疗。
所有5例患者均有玻璃体细胞。3例患者有明显的血管周围渗出。4例患者有灰白色视网膜浸润，3例患者伴有视网膜出血。3例患者有视网膜下小白点。3例患者出现视网膜水肿增厚，3例患者出现出血性视网膜坏死。最初3例患者被诊断为急性视网膜坏死（ARN），1例患者被诊断为弓形虫病，1例患者被诊断为霜样树枝状视网膜血管炎。2例患者玻璃体活检呈阳性，3例患者呈阴性。在这3例阴性患者中的2例，通过视网膜活检确诊。
对于中老年患者视网膜血管炎或坏死性视网膜炎的鉴别诊断，应考虑眼部淋巴瘤。视网膜活检可能有助于确诊。
