Filipec M, Karel I, Michalicková M
II. ocní klinika 1. LF UK, Praha.
Cesk Oftalmol. 1993 Apr;49(2):72-5.
A thirty-year-old patient irradiated five years previously on account of a cerebral tumour was admitted for pars plana vitrectomy with the diagnosis of bilateral chronic uveitis and secondary glaucoma. The intraocular inflammation was characterized by corneal precipitates, pseudohypopyon, circulating large cell conglomerates in the anterior chamber and a dense whitish infiltration of the vitreous cavity. Because an intraocular malignant lymphoma was suspected, repeatedly a diagnostic pars plana vitrectomy was performed on the right eye and once on the left eye and bilateral actinotherapy was administered. Only the last cytological examination revealed the presence of lymphoma cells. The course of the disease on the two eyes differed. In the right eye despite repeated actinotherapy and repeated pars plana vitrectomy the disease proceeded by infiltration of the retina and the optic disc. In the left eye after par plana vitrectomy the finding on the ocular fundus was permanently without focal changes. An intraocular malignant lymphoma is usually masked by the picture of chronic uveitis. Careful analysis of the case-history, clinical picture and above all the awareness of this life threatening disease, are decisive for establishment of the correct diagnosis.
一名30岁患者曾因脑肿瘤于5年前接受过放疗，现因双侧慢性葡萄膜炎和继发性青光眼入院接受玻璃体切除术。眼内炎症的特征为角膜后沉着物、假性前房积脓、前房内循环的大细胞团块以及玻璃体腔致密的白色浸润。由于怀疑患有眼内恶性淋巴瘤，遂对右眼反复进行诊断性玻璃体切除术，对左眼进行了一次，并给予双侧放射治疗。仅最后一次细胞学检查发现存在淋巴瘤细胞。双眼的病程有所不同。右眼尽管反复进行放射治疗和玻璃体切除术，但疾病仍通过视网膜和视盘浸润发展。左眼在玻璃体切除术后眼底检查结果一直无局灶性改变。眼内恶性淋巴瘤通常被慢性葡萄膜炎的表现所掩盖。仔细分析病史、临床表现，尤其是对这种危及生命疾病的认识，对确立正确诊断起决定性作用。
