Division of Ophthalmology, University of Cape Town, Cape Town, South Africa.
Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
Ocul Immunol Inflamm. 2021 Apr 3;29(3):621-627. doi: 10.1080/09273948.2020.1751856. Epub 2020 May 26.
: To describe the epidemiology, clinical characteristics, diagnosis and treatment of human immunodeficiency virus (HIV)-related primary vitreoretinal lymphoma (PVRL).: Narrative literature review.: HIV-related PVRL occurs in persons who are relatively young and generally have very low CD4+ T-cell counts. Vitritis with subretinal or sub-retinal pigment epithelial infiltrates is typical. Vitreous cytology remains the gold standard for diagnosis, supplemented by flow cytometry and genetic analyses of tumor cells, and measurement of aqueous or vitreous interleukin-10 levels. Concurrent brain involvement also may establish the diagnosis. Treatment includes antiretroviral therapy (ART), systemic chemotherapy (usually methotrexate-based) and local ocular treatment (intravitreal methotrexate, intravitreal rituximab, external beam radiotherapy). Systemic chemotherapy is of uncertain value for PVRL without other central nervous system involvement. Prognosis is poor, but has improved significantly compared to the pre-ART era.: Ophthalmologists should consider the diagnosis of PVRL in HIV-positive individuals who present with intermediate or posterior uveitis.
描述与人类免疫缺陷病毒（HIV）相关的原发性玻璃体视网膜淋巴瘤（PVRL）的流行病学、临床特征、诊断和治疗。
叙述性文献复习。
HIV 相关的 PVRL 发生在相对年轻的人群中，一般 CD4+T 细胞计数非常低。伴有脉络膜或视网膜下色素上皮浸润的眼色素层炎是典型的。玻璃体液细胞学检查仍然是诊断的金标准，辅助方法包括流式细胞术和肿瘤细胞的基因分析，以及测量房水或玻璃体液中白细胞介素-10 水平。同时发生的脑部受累也可能确立诊断。治疗包括抗逆转录病毒治疗（ART）、全身化疗（通常基于甲氨蝶呤）和局部眼部治疗（玻璃体内甲氨蝶呤、玻璃体内利妥昔单抗、外照射放疗）。对于没有其他中枢神经系统受累的 PVRL，全身化疗的价值不确定。与 ART 前时代相比，预后较差，但已显著改善。
眼科医生应考虑在出现中间或后葡萄膜炎的 HIV 阳性个体中诊断 PVRL。
