China
Africa
Explore chapters and articles related to this topic
Chorioretinal biopsy
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Intraocular lymphomas can also be classified by their location of origin. PIOL arises in the vitreous and retina, usually as a high-grade malignant B-cell NHL, possibly associated with primary CNS lymphoma. Primary uveal lymphomas commonly represent low-grade malignant B-cell NHL. Choroidal metastasis of systemic lymphoma represents the third type. Huemmeke et al22 reported two patients in whom different subtypes of intraocular lymphoma were suspected. Vitreous biopsy and chorioretinal biopsy techniques were used to differentiate the subtype in these patients.
Panuveitis
Published in Gwyn Samuel Williams, Mark Westcott, Carlos Pavesio, Bushra Thajudeen, Practical Uveitis, 2017
Gwyn Samuel Williams, Mark Westcott
Primary intraocular lymphoma presents with floaters and blur but rarely pain or photophobia. Examination will reveal cells and debris in the vitreous and possibly even what appears to be an anterior uveitis with keratic precipitates. So far so generic, but there are features that stand out, quite apart from the history, that point towards this diagnosis. The main feature is patches of subretinal tumour infiltration which are poorly defined yellow spots, dots or plaques, single or multiple, which appear under the retina (Figure 6.4). Other features include sheets of vitreous cells, the nature of which will raise suspicion of atypical vitritis, and an entirely white eye in the presence of significant anterior chamber cells. Otherwise PIOL can mimic any condition as cells leaving blood vessels can look like sheathing, occlusion of peripheral vessels can cause retinal necrosis, and cells in the anterior chamber can even form a hypopyon. Despite the presence of the above signs, cystoid macular oedema is quite rare (<3%) and the absence of CMO should raise suspicion. Finally, always think of this condition if the acuity is disproportionately worse or better than the clinical signs might suggest.
Primary central nervous system lymphoma
Published in Franco Cavalli, Harald Stein, Emanuele Zucca, Extranodal Lymphomas, 2008
Tracy T Batchelor, Andrés JM Ferreri
The therapeutic approach to intraocular lymphoma patients is challenging due to the limited knowledge of intraocular drug pharma-cokinetics, the limitations in achieving adequate intraocular drug concentrations when administered by the intravenous route,62 and the high rates of persistent disease in the eyes after conventional therapy. Some protocols using intravitreal injections of MTX, with or without thiotepa, are currently ongoing. A weekly intravitreal injection of 400 μg of MTX/0.1 ml, for 4 weeks, and once a month thereafter, has produced encouraging results and low morbidity.63
A Validation Study of the Revised Diagnostic Criteria from the International Workshop on Ocular Sarcoidosis at a Single Institute in Japan
Published in Ocular Immunology and Inflammation, 2021
Mari Handa-Miyauchi, Hiroshi Takase, Miyuki Tanaka, Masako Akiyama, Kyoko Ohno-Matsui, Manabu Mochizuki
A total of 323 patients (123 men and 200 women; mean age, 54 years; range, 6–88 years) took part in the study. Among them, 51 patients were confirmed to have sarcoidosis by histopathologic examination of biopsy specimens of non-ocular organs. The remaining 272 control patients had idiopathic uveitis and uveitis of other etiologies such as herpetic anterior uveitis, Vogt-Koyanagi-Harada disease, and Behçet’s disease. Intraocular lymphoma, which is not an intraocular inflammatory disease, was also included in the control group because it sometimes masquerades as uveitis, including sarcoidosis, by forming vitreous opacity or retinal white lesions. Other clinical entities of uveitis included juvenile idiopathic arthritis (two patients), retinal vasculitis (2), ulcerative colitis (2), HLA-B27 positive acute anterior uveitis (1), anti-neutrophil cytoplasmic autoantibody associated vasculitis (1), ocular toxoplasmosis (1), psoriasis (1), rubella associated uveitis (1), syphilis (1), and white dot syndrome (1). Table 1 shows the diagnoses of patients.
Unilateral Idiopathic Choroidal Effusion in a Patient Who Takes Sulfonamides
Published in Ocular Immunology and Inflammation, 2021
The general rule in ophthalmology is to recognize either sight threatening or, even more important, life-threatening conditions. Hence, we need to be very careful when we challenge with difficult cases, especially when a patient or its sight seem stable or “normal.” The presented patient was symptomatic and he had obvious signs of abnormality. In spite of making definite diagnosis is challenging due to overlap of clinical signs as well as the coincidence of taking sulfonamides. Over workup period we excluded some of possible differential diagnoses as sarcoidosis, syphilis, and tuberculosis in the very early stage of workup.9 Based on additional imaging tests done in Uveitis service there was a high suspicion of malignancy. Due to the absence of pigmentary changes we excluded diffuse uveal melanoma as differential diagnosis. An intraocular lymphoma is one of the top listed possible neoplastic causes. According to WHO classification, there is a clear distinction among primary vitreoretinal and primary/secondary choroidal lymphoma.6 The latter one does not manifest with vitritis while the hallmark of the primary vitreoretinal lymphoma are vitreous cells and subretinal pigment deposits.10 Then, primary vitreoretinal lymphoma is bilateral in 80% of cases. On the other hand, choroidal lymphomas are mostly unilateral with yellowish choroidal lesions as classic features. Choroidal effusion is possible in both types of intraocular lymphoma, although it is more often in choroidal lymphomas. In addition, primary vitreoretinal lymphoma is aggressive while choroidal lymphoma has a more benign course.
Intraocular Lymphoma
Published in Ocular Immunology and Inflammation, 2021
Emmett T. Cunningham, Elisabetta Miserocchi, Justine R. Smith, John A. Gonzales, Manfred Zierhut
Together, these studies highlight continued challenges associated with the diagnosis and management of intraocular lymphoma. While clinical and ophthalmic imaging findings often suggest the diagnosis, additional testing typically involves contrast-enhanced CNS or full-body CT or CT/PET imaging to evaluate for extraocular involvement in patients suspected of having VRL or uveal lymphoma, respectively. Diagnosis frequently involves tissue, vitreous, or aqueous humor biopsy followed by specialized cytologic, immunologic, and/or genetic analyses. Treatment is most often multidisciplinary and patient-specific, with options including both local and systemic chemotherapy, with or without regional radiotherapy. Testing for HIV infection should be performed in patients found to have VRL, and those who are HIV-positive should be considered for ART.