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Konda SM, Deaner JD, Proia AD, Jaffe GJ. PRIMARY VITREORETINAL LYMPHOMA MASQUERADING AS POSTOPERATIVE ENDOPHTHALMITIS IN A PREGNANT PATIENT WITH LONG-STANDING IDIOPATHIC PANUVEITIS. Retin Cases Brief Rep 2024; 18:468-472. [PMID: 37037028 DOI: 10.1097/icb.0000000000001430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
PURPOSE To report primary vitreoretinal lymphoma after surgical 0.59 mg fluocinolone acetonide implant (FAi) exchange in a patient treated with adalimumab for idiopathic bilateral panuveitis. METHODS Retrospective case review. RESULTS A 37-year-old woman with bilateral idiopathic panuveitis, who had favorable responses to previous FAi surgical implants, presented with right eye recurrent intraocular inflammation and cystoid macular edema that partially responded to systemic adalimumab. Her FAi was replaced, given her previous favorable response. She developed postoperative ocular inflammation transiently responsive to two serial vitreous taps and injections of intravitreal antimicrobials and then worsening inflammation and new layered flocculant material. Diagnostic vitrectomy showed a few atypical lymphocytes and cultures were negative. At postdiagnostic vitrectomy Month 1, flocculant material recurred. Aqueous cytology and flow cytometry revealed large CD45-positive B cells suspicious for lymphoma. Postoperatively, she revealed that she was pregnant. She was treated with eight monthly intravitreal methotrexate injections and postpartum consolidation radiotherapy. Subsequent repeat cytology, flow cytometry, and corneal pathologic examination revealed large B cells that were CD20 positive, and next-generation sequencing detected a dominant monoclonal B-cell population, diagnostic of PVRL. Nineteen months after FAi exchange, she developed an area of enhancement in the lateral aspect of the right frontal lobe on brain MRI, consistent with central nervous system involvement. CONCLUSION The authors present a unique case of PVRL masquerading as postoperative endophthalmitis after FAi exchange in an eye with chronic panuveitis treated with adalimumab immunosuppressive therapy. The authors hypothesize that there may be a causal relationship between adalimumab and PVRL.
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Affiliation(s)
- Sri Meghana Konda
- Department of Ophthalmology, Duke University, Durham, North Carolina. Dr. Deaner is now at Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Jordan D Deaner
- Department of Ophthalmology, Duke University, Durham, North Carolina. Dr. Deaner is now at Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Alan D Proia
- Department of Ophthalmology, Duke University, Durham, North Carolina. Dr. Deaner is now at Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; and
- Departments of Ophthalmology and Pathology, Duke University, Durham, North Carolina
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina. Dr. Deaner is now at Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; and
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Guan W, Xiao Y, Zhao H, Hu F, Chen C, Peng X. Spectral-domain optical coherence tomography biomarkers in vitreoretinal lymphoma. Clin Exp Ophthalmol 2023; 51:144-153. [PMID: 36567492 DOI: 10.1111/ceo.14197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/13/2022] [Accepted: 12/18/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although early detection is critical, diagnosing vitreoretinal lymphoma (VRL) remains difficult. We sought to assess the potential diagnostic value of spectral-domain optical coherence tomography (SD-OCT) in VRL. METHODS We reviewed the clinical records and pre-treatment SD-OCT images of biopsy-confirmed VRL and uveitis patients, with primary involvement of the sub-retinal pigment epithelium (RPE) and the outer retina, including acute syphilitic posterior placoid chorioretinitis (ASPPC), chronic stage sympathetic ophthalmitis (SO), and idiopathic multifocal choroiditis (MFC). RESULTS We included 45 eyes of 45 VRL patients and 40 eyes of 40 uveitis patients (17 ASPPC eyes, eight chronic SO eyes, and 15 MFC eyes). On SD-OCT, lymphoma cell infiltration was observed in various retinal layers, most commonly in the sub-RPE (80%) and sub-retinal space (62%). Highly sensitive features for VRL as compared to uveitis included vitreous cells (93%), focal hyper-reflective sub-retinal infiltration (51%), and diffuse RPE elevations (56%). The features strongly specific for VRL included preretinal deposits (92.5%), intra-retinal infiltration (except the incomplete vertical hyper-reflective type, 100%), banded hyper-reflective sub-retinal infiltration (90%), and confluent RPE detachments (100%). We identified an approach to VRL diagnosis based on these SD-OCT findings: (1) two highly sensitive features plus one strongly specific feature; or (2) one highly sensitive feature plus two strongly specific features, demonstrated a sensitivity of 80% and specificity of 95% for VRL. CONCLUSIONS The SD-OCT may enable the detection of detailed lymphoma infiltration characteristics and provide significant supplemental value for VRL diagnosis, particularly when combining highly sensitive and specific VRL-associated SD-OCT features.
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Affiliation(s)
- Wenxue Guan
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuanyuan Xiao
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Huiying Zhao
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Department of Ophthalmology, Beijing Geriatric Hospital, Beijing, China
| | - Feng Hu
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chunli Chen
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Peng
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Agarwal A, Sharma D, Mahajan S, Prakash G, Sharma S, Kumar A, Sehgal S, Gupta N, Kapila AT, Lal V, Gupta V, Pulido JS. Diagnostic and Therapeutic Challenges. Retina 2021; 41:2625-2630. [PMID: 33438898 DOI: 10.1097/iae.0000000000003112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Bradley S Gundlach
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
| | - Marcel M Maya
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, Los Angeles
| | - Irena Tsui
- Retina Division, Stein Eye Institute, University of California, Los Angeles, Los Angeles.,Doheny Eye Institute, University of California, Los Angeles, Los Angeles
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Multimodal imaging characteristics in eyes with vitreoretinal lymphoma treated with intravitreal rituximab. Int Ophthalmol 2021; 41:2711-2722. [PMID: 33834345 DOI: 10.1007/s10792-021-01828-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To characterize the imaging features in eyes with vitreoretinal lymphoma (VRL) using ultra-widefield fundus photography (UWF-FP), swept-source optical coherence tomography (SSOCT) and fundus autofluorescence (FAF) that are correlated to ongoing treatment with intravitreal Rituximab(IVR). METHODS Retrospective observational imaging-based study of 15 treatment-naive eyes with VRL treated with IVR. All patients with primary VRL underwent vitreous biopsy using 23/25G microincision vitrectomy system for confirmation of diagnosis. All eyes received monthly IVR (1 mg/0.1 mL) injections till disease remission. Baseline clinical characteristics, treatment details, outcomes, and sequential imaging features on UWF-FP, FAF, and SSOCT were analyzed. OUTCOME MEASURES Baseline features and changes in UWF-FP, FAF patterns, and SSOCT features in response to treatment RESULTS: Clinically, patients presented with sub-RPE deposits (n = 15), superficial retinal hemorrhages (n = 2), 'giant' RPE (retinal pigment epithelium) holes (n = 2), and anterior segment reaction (n = 1). Eyes were treated with mean 5.7 IVR injections (median: 5; range 1-13) over a mean 7.2 ± 4.9 months. During the course of treatment, two eyes developed superficial retinal hemorrhages with spontaneous resolution, 2 eyes developed CME, and 4 eyes developed characteristic 'leopard skin' pigmentation. Hyper-autofluorescence corresponding to areas of active lesions decreased with each treatment cycle and was finally replaced by hypo-autofluorescence. Serial OCTs showed regression of sub-RPE/subretinal deposits (n = 15), ellipsoid zone disruption (n = 9), and its resolution with treatment (n = 3), epiretinal membrane (ERM; n = 6), choroidal hyperreflective foci (HRF; n = 4), disorganization of retinal inner layers (DRIL; n = 3), RPE-rip (n = 2), cystoid macular edema (CME; n = 2), and hyperreflective lesions in the choroid (n = 1). Complete resolution was observed in all eyes with extensive hypo-AF. The central foveal thickness decreased from 237 ± 113 μ to 182 ± 114 μ (p = 0.1) and subfoveal choroidal thickness decreased from 258 ± 66 μ to 220 ± 64 μ (p = 0.12) at final follow-up. The mean baseline BCVA was logMAR 0.9 ± 0.9 that deteriorated to mean logMAR 1 ± 1 final visit (p = 0.7). The mean recurrence-free follow-up was 5.9 ± 5.1 months CONCLUSION: Multimodal imaging provides novel insights into features of VRL, a better understanding of regression patterns, and prognostication of outcomes when treated with intravitreal rituximab. Larger, multicentric studies with longer follow-up will help unravel imaging biomarkers to understand these aspects better.
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Deák GG, Sneed SR, Jampol LM. CYSTOID MACULAR EDEMA IN THE SETTING OF PRIMARY VITREORETINAL LYMPHOMA. Retin Cases Brief Rep 2021; 15:104-106. [PMID: 30015778 DOI: 10.1097/icb.0000000000000797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To present a rare case of primary vitreoretinal lymphoma presenting with cystoid macular edema without previous surgical intervention or radiotherapy. METHODS Retrospective chart review of one patient. RESULTS A 74-year-old patient was seen with a history of cataract surgery in 1 eye and presumed ocular inflammation with recurrent cystoid macular edema in both eyes. On examination, subretinal pigment epithelial and intraretinal infiltrates raised the suspicion of primary vitreoretinal lymphoma despite the unusual presentation with cystoid macular edema. A magnetic resonance imaging and brain biopsy confirmed the diagnosis of vitreoretinal lymphoma in the setting of central nervous system lymphoma. CONCLUSION Primary vitreoretinal lymphoma can present with cystoid macular edema in rare cases.
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Affiliation(s)
- Gábor G Deák
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria ; and
| | - Scott R Sneed
- Associated Retinal Consultants, Traverse City, Michigan
| | - Lee M Jampol
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Chiu S, Mudhar HS, Harrison B, Spiteri-Cornish K, Sears K. Cystoid Macular Oedema as a Presenting Feature of Vitreoretinal Lymphoma. Ocul Oncol Pathol 2020; 6:318-322. [PMID: 33123523 DOI: 10.1159/000508890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/02/2020] [Indexed: 11/19/2022] Open
Abstract
A 69-year-old female presented with right vitreous cells and cystoid macular oedema (CMO). One year previously, she had received two cycles of attenuated methotrexate-based chemotherapy for primary central nervous system (CNS) lymphoma, abandoned due to toxicity. There was no past ocular history of note aside from mild cataract. Due to her history of previous CNS lymphoma, we suspected vitreoretinal lymphoma (VRL), but the presence of the CMO made this unlikely. She underwent a diagnostic vitrectomy. Histology and immunohistochemistry showed the presence of a high-grade B-cell VRL.
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Affiliation(s)
- Stephanie Chiu
- Department of Ophthalmology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Hardeep Singh Mudhar
- Department of Histopathology, National Specialist Ophthalmic Pathology Service (NSOPS), Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Beth Harrison
- Department of Haematology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Kurt Spiteri-Cornish
- Department of Ophthalmology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Katharine Sears
- Department of Ophthalmology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
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Ma Y, Zhao H, Peng X. Choroidal neovascularization as a complication of primary vitreous retinal lymphoma. Eur J Ophthalmol 2020; 31:NP31-NP35. [PMID: 32551977 DOI: 10.1177/1120672120934966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe a case of primary vitreous retinal lymphoma (PVRL) complicated with choroidal neovascularization (CNV) and presented with severe macular edema (ME). CASE DESCRIPTION A 52-year-old female patient was diagnosed with bilateral PVRL. Optical coherence tomography (OCT) showed severe macular edema (ME) and subretinal hyperreflective material in the left eye at the first visit. No sign of choroidal neovascularization (CNV) was found with fundus fluorescein angiography (FFA) or indocyanine green angiography (ICGA). The ME was resolved after standard intraocular chemotherapy, while the subretinal hyperreflective material remained stable. Optical coherence tomography angiography (OCTA) was performed 2 years after chemotherapy. OCTA revealed a well-circumscribed CNV network in the subretinal hyperreflective material. CONCLUSION It is a rare occurrence that CNV and ME developed in this PVRL patient. The presence of ME is not an exclusion criterion for PVRL. This case should also raise awareness of the importance of OCTA as a method for monitoring intraocular lymphoma during follow-up.
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Affiliation(s)
- Ya Ma
- Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Huiying Zhao
- Ophthalmology Department, Beijing Geriatric Hospital, Beijing, China
| | - Xiaoyan Peng
- Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Optical coherence tomography diagnostic signs in posterior uveitis. Prog Retin Eye Res 2020; 75:100797. [DOI: 10.1016/j.preteyeres.2019.100797] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/31/2019] [Accepted: 09/05/2019] [Indexed: 12/22/2022]
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Kvopka M, Lake SR, Smith JR. Intraocular chemotherapy for vitreoretinal lymphoma: A review. Clin Exp Ophthalmol 2019; 48:240-248. [DOI: 10.1111/ceo.13668] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/18/2019] [Accepted: 10/20/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Michael Kvopka
- Flinders University College of Medicine and Public Health Adelaide South Australia Australia
| | - Stewart R. Lake
- Ophthalmology Unit – Division of Surgery, Flinders Medical Centre Adelaide South Australia Australia
| | - Justine R. Smith
- Flinders University College of Medicine and Public Health Adelaide South Australia Australia
- Ophthalmology Unit – Division of Surgery, Flinders Medical Centre Adelaide South Australia Australia
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Touhami S, Audo I, Terrada C, Gaudric A, LeHoang P, Touitou V, Bodaghi B. Neoplasia and intraocular inflammation: From masquerade syndromes to immunotherapy-induced uveitis. Prog Retin Eye Res 2019; 72:100761. [DOI: 10.1016/j.preteyeres.2019.05.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 04/16/2019] [Accepted: 05/01/2019] [Indexed: 12/18/2022]
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