[Diagnostics and treatment of primary vitreoretinal lymphoma]

BACKGROUND

Primary vitreoretinal lymphoma (PVRL) is a rare ocular lymphoid malignancy, mostly a diffuse large B-cell lymphoma. The PVRL, previously called primary intraocular lymphoma (PIOL), is a subset of primary central nervous system lymphoma (PCNSL).

DIAGNOSIS

The diagnosis of PVRL is often difficult as it often mimics chronic intermediate or posterior uveitis; therefore, PVRL requires various procedures for the diagnostics, e.g. immunohistochemistry, cytology, pathology, molecular pathology and cytokine analysis (interleukin 10) after surgically obtaining ocular specimens.

THERAPY

Treatment forms that are effective for systemic lymphomas have not been reliably successful for PVRL and PCNSL. Current management of PVRL consists of chemotherapy, such as methotrexate or rituximab, possibly combined with external beam radiation whereby both chemotherapeutic agents are administered systemically as well as intravitreally. Intravitreal treatment alone is recommended solely in the case of monocular PVRL, which is highly controversial. A PVRL usually responds well to initial treatment; however, relapse rates and CNS involvement are high, resulting in a poor prognosis and limited survival.

[Bacterial Keratitis]

Worldwide inflammatory corneal diseases are considered to be one of the leading causes of monocular blindness. Bacterial infectious are still predominant and are found in 80 % of patients with ulcerative keratitis. In recent years, both changes in risk conditions and changes in the bacterial spectrum can be observed. Contact lenses and refractive surgery are factors that have increased in importance according to some studies. Microorganisms especially Pseudomonas spp. and atypical mycobacteria are detectable in these patients. In contrast, the bacterial keratitis is observed less frequently after trauma. The broad, often unsighted use of highly effective antimicrobial agents, especially of fluoroquinolones is assumed to be a factor in the transformation of the microbial spectrum. Due to the frequent course of keratitis and a targeted, effective therapy to initiate a pathogen is desirable. The possibilities of diagnostics have been expanded in recent years by molecular biological techniques, but cannot replace established methods. The aim of this paper is to provide a positioning on current aspects of bacterial keratitis.