Lu Brianna, Wong Jovi C Y, Kritzinger Justin, Wong David T
Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
Case Rep Ophthalmol. 2024 Aug 8;15(1):607-613. doi: 10.1159/000540051. eCollection 2024 Jan-Dec.
Primary vitreoretinal lymphoma (PVRL) is a rare malignant tumor that typically involves the retina, vitreous, or optic nerve head. PVRL often occurs concurrently with central nervous system lymphoma. Here, we present the first report of a patient with biopsy-confirmed PVRL presenting solely with asymptomatic peripheral drusenoid lesions.
A woman in her 70s presented with new elevated amelanotic yellow lesions with overlying pigment in both of her eyes not previously seen prior to cataract surgery. Over the next 4 months, there was waxing and waning of lesions which resolved and first appeared in the right eye and then the left. A diagnostic vitrectomy of the left eye revealed B-cell lymphoma. The patient elected for initial treatment with radiation therapy of both orbits. A new lesion was identified in her right eye nearly 18 months after starting maintenance therapy with ibrutinib, following which systemic chemotherapy with methotrexate was initiated.
Elevated clinical suspicion for a malignant process is needed for patients with progressive new retinal lesions in older age. Local radiation therapy to the orbits alone may not be sufficient to prevent progression despite initial presentation showing confinement of disease to the intraocular space.
原发性玻璃体视网膜淋巴瘤（PVRL）是一种罕见的恶性肿瘤，通常累及视网膜、玻璃体或视神经乳头。PVRL常与中枢神经系统淋巴瘤同时发生。在此，我们报告首例经活检确诊的PVRL患者，其仅表现为无症状的周边玻璃膜疣样病变。
一名70多岁的女性患者，双眼出现新的、隆起的无色素性黄色病变，伴有色素沉着，这在白内障手术前未曾见过。在接下来的4个月里，病变反复出现和消退，首先出现在右眼，然后是左眼。左眼诊断性玻璃体切除术显示为B细胞淋巴瘤。患者选择首先对双侧眼眶进行放射治疗。在开始使用伊布替尼维持治疗近18个月后，右眼发现一个新病变，随后开始使用甲氨蝶呤进行全身化疗。
对于老年患者出现进行性新的视网膜病变，需要提高对恶性病变的临床怀疑。尽管最初表现为疾病局限于眼内空间，但仅对眼眶进行局部放射治疗可能不足以防止疾病进展。
