Kitao Masahiro, Hashida Noriyasu, Nishida Kohji
Department of Ophthalmology, Osaka University Graduate School of Medicine, E7, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
BMC Ophthalmol. 2016 Jul 8;16:103. doi: 10.1186/s12886-016-0279-0.
Primary vitreoretinal lymphoma (PVRL) is a rare and fatal ocular malignancy that is mostly classified as diffuse large B cell lymphoma (DLBCL). PVRL is often fatal because of its association with the central nervous system (CNS). PVRL frequently masquerades as uveitis and sometimes recurs in clinical findings as keratic precipitates (KPs) and subretinal lesions. Pseudohypopyon is one of the clinical findings of the local recurrence of PVRL and is treated with radiotherapy; however, the effectiveness of local control with an intravitreal injection of methotrexate (MTX) has not yet been determined. We herein present a case of recurrent vitreoretinal lymphoma that repeatedly developed pseudohypopyon and treated with intravitreal MTX.
A 64-year-old woman was diagnosed with PVRL involving primary central nervous system lymphoma (PCNSL). She received radiotherapy to the whole brain and a local ocular treatment, which resulted in temporary remission of the disease. Pseudohypopyon was detected during the follow-up. It was 2-mm high, viscous, and swollen in the center. Anterior chamber biopsy revealed the presence of atypical lymphocytes, indicating the recurrence of DLBCL. Pseudohypopyon was treated with intravitreal methotrexate and completely disappeared. Pseudohypopyon has since repeatedly appeared and been treated with intravitreal MTX each time. The recurrence of PVRL with KPs and subretinal invasion was treated with intravitreal MTX each time. Recurrence with pseudohypopyon was not simultaneous with KPs or subretinal invasion. No CNS involvement was detected during the observation period.
Pseudohypopyon is one of the signs of recurrent vitreoretinal lymphoma. Although pseudohypopyon was temporarily controlled with intravitreal MTX, this treatment did not completely induce its remission.
原发性玻璃体视网膜淋巴瘤（PVRL）是一种罕见的致命性眼部恶性肿瘤，大多归类为弥漫性大B细胞淋巴瘤（DLBCL）。PVRL常因与中枢神经系统（CNS）相关而致命。PVRL常伪装成葡萄膜炎，有时在临床表现中以角膜后沉着物（KP）和视网膜下病变的形式复发。假性前房积脓是PVRL局部复发的临床表现之一，采用放射治疗；然而，玻璃体内注射甲氨蝶呤（MTX）进行局部控制的有效性尚未确定。我们在此报告一例复发性玻璃体视网膜淋巴瘤病例，该病例反复出现假性前房积脓，并接受了玻璃体内MTX治疗。
一名64岁女性被诊断为患有累及原发性中枢神经系统淋巴瘤（PCNSL）的PVRL。她接受了全脑放疗和局部眼部治疗，疾病暂时缓解。随访期间发现假性前房积脓。其高度为2毫米，质地黏稠，中央隆起。前房活检发现存在非典型淋巴细胞，提示DLBCL复发。假性前房积脓采用玻璃体内甲氨蝶呤治疗后完全消失。此后假性前房积脓反复出现，每次均采用玻璃体内MTX治疗。PVRL伴KP和视网膜下侵犯的复发每次均采用玻璃体内MTX治疗。假性前房积脓复发与KP或视网膜下侵犯不同时出现。观察期间未发现CNS受累。
假性前房积脓是复发性玻璃体视网膜淋巴瘤的体征之一。虽然玻璃体内MTX可暂时控制假性前房积脓，但该治疗并未完全诱导其缓解。
