Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA.
Br J Ophthalmol. 2023 Jun;107(6):786-789. doi: 10.1136/bjophthalmol-2021-319483. Epub 2022 Feb 21.
BACKGROUND/AIMS: Uveal lymphoid hyperplasia (formerly benign reactive hyperplasia of the choroid) spans histopatholological characteristics ranging from reactive hyperplasia to low-grade lymphoid neoplasm. There is strong evidence that other low-grade lymphoid neoplasms, particularly of gastric derivations, respond to oral antibiotics. Here, we explore that response of uveal lymphoid hyperplasia to treatment with only oral antibiotics and steroids.
Four eyes of three patients with clinically diagnosed uveal lymphoid hyperplasia were treated with a course of oral antibiotics and steroids. The main outcome was clinical response of choroidal infiltrate by optical coherence tomography (OCT) measurements of choroidal thickness and visual acuity. Secondary outcome measure included local and systemic recurrence. Clinical response was evaluated by clinical exam, fundus photography, ultrasound and OCT.
All 4 eyes displayed a clinical response at a median 2 weeks after starting oral antibiotics and steroid course. The choroidal infiltration regressed as evidenced by: decrease of choroidal thickness by a median of 421 nm, myopic shift in refractive error by a median of 0.50 Diopters, and improved vision by a median of 1.5 Snellen lines. At a median of 51-month follow-up, all four eyes had a sustained complete response and no patient has developed systemic disease to date.
In this small cohort of patients with uveal lymphoid hyperplasia, measurable and sustained clinical responses were observed with antibiotics/steroids, without systemic recurrence. This suggests combination antibiotic/steroid therapy is a reasonable treatment for select cases of uveal lymphoid hyperplasia, and may avoid the need for systemic chemotherapy/monoclonal antibody and/or external beam irradiation.
背景/目的：葡萄膜淋巴组织增生（以前称为脉络膜良性反应性增生）的组织病理学特征范围从反应性增生到低度淋巴肿瘤。有强有力的证据表明，其他低度淋巴肿瘤，特别是胃来源的低度淋巴肿瘤，对口服抗生素有反应。在这里，我们探讨了仅用口服抗生素和类固醇治疗葡萄膜淋巴组织增生的反应。
3 名患者的 4 只眼临床诊断为葡萄膜淋巴组织增生，给予口服抗生素和类固醇治疗。主要结局是通过光学相干断层扫描（OCT）测量脉络膜厚度和视力来评估脉络膜浸润的临床反应。次要结局指标包括局部和全身复发。临床反应通过临床检查、眼底照相、超声和 OCT 进行评估。
所有 4 只眼在开始口服抗生素和类固醇治疗后 2 周中位数时均显示出临床反应。脉络膜浸润随着脉络膜厚度中位数减少 421nm、近视折射误差中位数减少 0.50 屈光度和视力中位数提高 1.5 行 Snellen 线而消退。在中位数为 51 个月的随访中，所有 4 只眼均持续完全缓解，迄今为止没有患者发生全身疾病。
在葡萄膜淋巴组织增生的这一小队列患者中，观察到抗生素/类固醇治疗的可测量和持续的临床反应，且无全身复发。这表明，抗生素/类固醇联合治疗可能是葡萄膜淋巴组织增生的一种合理治疗方法，可能避免了全身化疗/单克隆抗体和/或外照射的需要。
