Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Ocular Oncology Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
J Med Case Rep. 2022 Apr 24;16(1):162. doi: 10.1186/s13256-022-03373-z.
We describe the outcome of ultra-low-dose radiotherapy plus intravitreal methotrexate and rituximab injections for a patient with primary choroidal lymphoma who presented with nodular conjunctival salmon patches and extensive serous retinal detachment.
A 34-year-old Iranian man presented with a nodular patch of bulbar conjunctiva in the right eye, and 1+ vitritis. A nearly complete shallow serous retinal detachment, retinal folds, and multifocal yellow choroidal infiltrates were seen during a fundus examination of the right eye. Enhanced depth imaging optical coherence tomography revealed macular retinal folds and an uneven, undulating, "seasick" appearance of the choroidal surface with choriocapillaris compression, intraretinal and subretinal fluid, and clusters of optically dense material at the outer retinal level. An incisional biopsy of the conjunctival lesion confirmed the diagnosis of primary choroidal lymphoma with epibulbar involvement. The patient was treated with ultra-low-dose "boom-boom" radiation (4 Gy delivered in two fractions over two consecutive days) as well as intravitreal methotrexate and rituximab injections. After a year, the lesions had completely disappeared, with no adverse effects or recurrence.
Ultra-low-dose (boom-boom) radiotherapy combined with intravitreal chemotherapy and/or immunotherapy may be an effective treatment for primary choroidal lymphoma with anterior epibulbar extension and diffuse subretinal fluid with favorable response and minimal side effects.
我们描述了一位患有原发性脉络膜淋巴瘤的患者的治疗结果，该患者表现为结节性结膜鲑鱼斑和广泛的浆液性视网膜脱离，接受了超低剂量放射治疗加玻璃体内甲氨蝶呤和利妥昔单抗注射。
一名 34 岁的伊朗男性因右眼出现一个结节状的球结膜斑块和 1+ 睫状体炎而就诊。右眼眼底检查发现几乎完全的浅层浆液性视网膜脱离、视网膜皱褶和多灶性黄色脉络膜浸润。增强深度成像光学相干断层扫描显示黄斑视网膜皱褶和脉络膜表面不均匀、波浪状的“晕船”外观，伴有脉络膜毛细血管受压、视网膜内和视网膜下液以及外层视网膜水平的光密度物质簇。结膜病变的切开活检证实了原发性脉络膜淋巴瘤伴眼外侵犯的诊断。该患者接受了超低剂量“砰砰”放疗（4 Gy 在两天内分两次给予）以及玻璃体内甲氨蝶呤和利妥昔单抗注射治疗。一年后，病变完全消失，无不良反应或复发。
超低剂量（砰砰）放疗联合玻璃体内化疗和/或免疫治疗可能是一种有效的治疗方法，适用于伴有前眼外侵犯和弥漫性视网膜下积液的原发性脉络膜淋巴瘤，具有良好的反应和最小的副作用。
