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Levine ES, Batra NN. Multimodal imaging in a case of presumed secondary vitreoretinal lymphoma presenting with inner retina and optic nerve head infiltration. Am J Ophthalmol Case Rep 2024; 34:102040. [PMID: 38532849 PMCID: PMC10963182 DOI: 10.1016/j.ajoc.2024.102040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 03/28/2024] Open
Abstract
Purpose To report the findings supported by multimodal imaging in a case of secondary vitreoretinal lymphoma presenting with inner retina and optic nerve head infiltration. Observations A 64-year-old man with systemic diffuse large B-cell lymphoma presented with reduced visual acuity. Moderate anterior chamber and vitreous cell were present. Fundus exam showed bilateral disc edema and diffuse opaque macular infiltrates with a pseudo cherry-red spot in the left eye. Optical coherence tomography showed inner retinal infiltration and loss of normal architecture. Surgery for tissue biopsy was discussed and declined due to risk. Instead, multimodal imaging and anterior chamber fluid sampling were used as a surrogate for tissue biopsy and helped rule out infectious uveitis and retinal vascular disease. The patient was empirically treated with intravitreal methotrexate with rapid improvement in vision, exam, and quality of life. Conclusions and importance Multimodal imaging can support a presumed diagnosis of secondary vitreoretinal lymphoma in order to proceed with intravitreal methotrexate treatment, which can result in rapid clinical and visual improvement.
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Affiliation(s)
- Emily S. Levine
- Section of Ophthalmology, Department of Surgery, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States
| | - Nikhil N. Batra
- Section of Ophthalmology, Department of Surgery, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States
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2
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Rissotto F, Cicinelli MV, Servillo A, Berni A, Menean M, Bianco L, Antropoli A, Bandello F, Miserocchi E, Marchese A. Multimodal Imaging of Vitreo-Retinal Lymphoma: A Comprehensive Review. Ocul Immunol Inflamm 2024:1-7. [PMID: 38436928 DOI: 10.1080/09273948.2024.2311754] [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: 05/24/2023] [Accepted: 01/24/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Vitreoretinal lymphoma (VRL) is a rare lymphoma affecting the vitreous and the retina. Clinical diagnosis is challenging and often delayed and may lead to aggravated prognosis. This study aims to review multimodal imaging findings in VRL. METHODS We performed a comprehensive narrative review of the multimodal imaging findings that might be useful in the detection of VRL lesions. RESULTS The most frequent ocular manifestations of VRL are vitritis, and retinal and sub-retinal Pigmented Epithelium (RPE) infiltrations. Color Fundus Photography (CFP) detects vitreous haze, optic nerve, retinal and sub-RPE infiltration. Ultra-wide field imaging allows visualization of different patterns of vitreous haze and monitoring of VRL evolution through the detection of chorio-retinal atrophy (CRA). Fundus Autofluorescence shows granular hypo- and hyper-autofluorescent pattern. Optical Coherence Tomography (OCT) reveals vitreous cells, vertical hyper-reflective lesions and sub-RPE infiltrates. Fluorescein Angiography (FA) shows hypo or hyperfluorescent round lesions at the late stages of the examination, while Indocyanine Green Angiography (ICGA) detects round areas of focal hypo-fluorescence in the early phases that gradually enlarge in the late phases. B-scan ultrasonography detects vitreous opacities and homogeneous hyperreflective corpuscular material in the vitreous, and is a strongly recommended tool in suspecting VRL and is particularly useful when vitreous haze is impeding retinal examination. CONCLUSION Diagnostic vitrectomy with cytopathological analysis remains the gold standard for VRL diagnosis, however multimodal imaging allows the identification of suggestive retinal and vitreal lesions for early suspicion, diagnosis, and treatment and monitoring disease progression and response to treatment.
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Affiliation(s)
- Federico Rissotto
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Servillo
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Alessandro Berni
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Matteo Menean
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Lorenzo Bianco
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Alessio Antropoli
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Elisabetta Miserocchi
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Alessandro Marchese
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
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Nguyen NV, Khan F, Cannon A, Huang Y, Kim L, Xu R, Rishi P, Conrady CD, Greiner TC, Yuil-Valdes A, Yeh S. Diagnosis of primary vitreoretinal lymphoma masquerading infectious retinitis by retinal biopsy. J Ophthalmic Inflamm Infect 2024; 14:8. [PMID: 38324143 PMCID: PMC10850038 DOI: 10.1186/s12348-024-00389-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/15/2024] [Indexed: 02/08/2024] Open
Abstract
PURPOSE To report a case of primary vitreoretinal lymphoma masquerading as infectious retinitis that was diagnosed via a retinal biopsy. OBSERVATIONS A 72-year-old female patient was referred to our ophthalmology clinic for evaluation of retinitis and vasculitis in the right eye (OD). On examination, best-corrected visual acuities (BCVAs) were hand motions OD and 20/20 in the left eye (OS). Fundus examination revealed optic disc edema and diffuse retinal whitening superior to the superotemporal arcade OD. Given the high suspicion of infectious retinitis, the patient was treated with intravitreal foscarnet, systemic acyclovir, and oral prednisone and underwent a comprehensive uveitis workup, which was unremarkable for viral and autoimmune entities. Given the patient's history of diffuse large B cell lymphoma with cutaneous involvement, vitreoretinal lymphoma was suspected, prompting pars plana vitrectomy with a retinal biopsy. Biopsy and immunohistochemistry results were consistent with B-cell lymphoma, and the patient was treated with high-dose methotrexate and rituximab. At 5-month follow-up, BCVAs were hand motions OD and 20/30 OS, and fundus examination demonstrated disc edema with resolution of retinal whitening OD. She responded well to the treatment with regression of vitreoretinal lymphoma on examination and is being monitored closely for lymphoma recurrence. CONCLUSIONS AND IMPORTANCE Although uncommon, patients with vitreoretinal lymphoma may masquerade as infectious retinitis, and vitreoretinal lymphoma should be suspected when refractory to antiviral therapy and in the setting of a negative workup for viral etiologies. Vitrectomy with retinal biopsy may be considered to aid the diagnosis of vitreoretinal lymphoma although careful consideration of the risks and benefits is warranted.
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Affiliation(s)
- Nam V Nguyen
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Ophthalmology, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Farid Khan
- Department of Ophthalmology, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Andrew Cannon
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ye Huang
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Ophthalmology, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lucas Kim
- Department of Ophthalmology, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
- Mercer University School of Medicine, Macon, GA, USA
| | - Rena Xu
- Department of Ophthalmology, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Pukhraj Rishi
- Department of Ophthalmology, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Christopher D Conrady
- Department of Ophthalmology, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Timothy C Greiner
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ana Yuil-Valdes
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Steven Yeh
- Department of Ophthalmology, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA.
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Wang P, An M, Zhang M, Yan X, Tong N. Acute retinal necrosis in a patient with cervical malignant tumor treated with sintilimab: a case report and literature review. Front Immunol 2024; 15:1301329. [PMID: 38322266 PMCID: PMC10844496 DOI: 10.3389/fimmu.2024.1301329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024] Open
Abstract
Acute retinal necrosis (ARN) is an inflammatory disease that is primarily caused by herpesvirus infection, most commonly varicella-zoster virus (VZV), followed by herpes simplex virus (HSV) and occasionally cytomegalovirus (CMV). Sintilimab is an immune checkpoint inhibitor (ICI) that can enhance the body's anti-tumor immune response. However, treatment with ICIs may lead to reactivation of the VZV. Here, we present a case of ARN caused by VZV infection in a patient receiving sintilimab for cervical cancer. A 64-year-old female patient developed vision loss and floaters with left eye redness for one week after 22 cycles of sintilimab for cervical cancer. Based on clinical manifestations, ophthalmological examination, and vitreous humor biopsy, the patient was diagnosed with acute retinal necrosis syndrome secondary to VZV. After receiving systemic antiviral and anti-inflammatory therapy, retinal necrosis lesions and visual function improved. In conclusion, clinicians should be aware of the risk of ARN when using sintilimab and should actively monitor patients for prompt diagnosis and optimal management of this rare adverse drug reaction.
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Affiliation(s)
- Pei Wang
- Department of Ophthalmology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, China
- School of Medicine, Qingdao University, Qingdao, Shandong, China
| | - Ming An
- Department of Ophthalmology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, China
| | - Mengmeng Zhang
- Department of Pathology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, China
| | - Xiaoran Yan
- Department of Ophthalmology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, China
| | - Nianting Tong
- Department of Ophthalmology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, China
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Lin ML, Hall AJ. Uveitis masquerade syndromes: An approach to diagnosis. Clin Exp Ophthalmol 2024; 52:91-105. [PMID: 37997019 DOI: 10.1111/ceo.14328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
Uveitis masquerade syndromes are a diverse group of clinical entities which mimic conventional immune-mediated uveitis due to the presence of inflammatory signs but are resistant to anti-inflammatory therapy. Misdiagnosis hinders appropriate management in these conditions and may result in poor outcomes. This review discusses commonly encountered neoplastic and non-neoplastic disease processes that masquerade as intraocular inflammation with a focus on relevant clinical features and adjunctive investigations that are helpful in reaching a correct diagnosis.
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Affiliation(s)
- Ming Lee Lin
- Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Anthony J Hall
- Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
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Rahman EZ, Shah P, Shah R. Metastatic squamous cell carcinoma masquerading as acute retinal necrosis. Am J Ophthalmol Case Rep 2023; 32:101934. [PMID: 37869266 PMCID: PMC10585213 DOI: 10.1016/j.ajoc.2023.101934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/17/2023] [Accepted: 09/26/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose To describe a case of retinal and optic nerve metastases masquerading as acute retinal necrosis secondary to primary squamous cell carcinoma of the lung. Observations A 66-year-old male with a history of Stage IV lung cancer, actively on chemotherapy, presented with right eye vision loss, an afferent pupillary defect, and partial visual field deficiencies. Exam revealed vitritis, macula-involving infiltrative retinitis, optic neuritis, and vasculitis of the right eye. The patient was treated empirically for acute viral retinitis with intravitreal foscarnet and ganciclovir injections and oral acyclovir and trimethoprim-sulfamethoxazole. A diagnostic pars plana vitrectomy with vitreous biopsy, intravitreal antivirals and silicone oil fill was performed. The resulting cytology was positive for malignant squamous cell carcinoma. Conclusions and importance We present a unique case of primary squamous cell carcinoma metastasizing to the retina and optic nerve which masqueraded as an acute viral retinitis. To date, there have not been any reported cases on Pubmed or Google Scholar at publication time of known squamous cell carcinoma metastases to the retina that demonstrated interval growth leading to emergent elevations in intraocular pressure (IOP). This case demonstrates the importance of considering metastasis when encountering an atypical acute retinal necrosis case, as well as bring awareness to the possibility that elevated IOP may be the first sign of interval metastases, despite surgical debulking, in cases involving known tumor metastases to the retina.
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Affiliation(s)
- Effie Z. Rahman
- Department of Ophthalmology, Atrium Health Wake Forest Baptist School of Medicine, Winston-Salem, NC, 27157, USA
- Retina Consultants of Texas, Retina Consultants of America, Bellaire, TX, USA
| | - Pooja Shah
- Department of Ophthalmology, Atrium Health Wake Forest Baptist School of Medicine, Winston-Salem, NC, 27157, USA
- Department of Ophthalmology, University of North Carolina Chapel Hill, Chapel Hill, NC, 27517, USA
| | - Rajiv Shah
- Department of Ophthalmology, Atrium Health Wake Forest Baptist School of Medicine, Winston-Salem, NC, 27157, USA
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Mehta N, Scholle T, Chevez-Barrios P, Schefler AC, Weng CY. PRIMARY CENTRAL NERVOUS SYSTEM AND VITREORETINAL LYMPHOMA MIMICKING VIRAL RETINITIS IN A YOUNG PATIENT. Retin Cases Brief Rep 2023; 17:567-571. [PMID: 37643044 DOI: 10.1097/icb.0000000000001255] [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: 08/31/2023]
Abstract
BACKGROUND/PURPOSE The purpose of this study was to report a young immunocompetent patient with primary central nervous system and vitreoretinal lymphoma initially presenting with peripheral retinitis. METHODS This study is a case report. RESULTS A 31-year-old woman presented with 20/60 vision in her left eye, vitreous haze, and peripheral retinal whitening. Intravitreal and oral antivirals were initiated for presumed acute retinal necrosis. Anterior chamber paracentesis was negative for viral nucleotide. Subretinal infiltrates developed, and vitreous biopsy was performed and interpreted as "negative except for rare yeast." Antifungal therapy was initiated. She developed multiple unilateral cranial neuropathies with multifocal areas of enhancement on neuroimaging. Lumbar puncture cytology was negative for neoplastic cells. After further worsening, aforementioned specimens were sent to a specialized ophthalmic pathology laboratory and the diagnosis revised to lymphoma of the diffuse B-cell type. Initial disease regression was seen after combined systemic and intraocular chemotherapy; unfortunately, the patient suffered a central nervous system recurrence and died from systemic complications 1 year later. CONCLUSION There has been an increased incidence of primary central nervous system and vitreoretinal lymphoma in young patients. Although vitreous biopsy is the diagnostic gold standard for vitreoretinal lymphoma, a risk of false negative interpretation exists. A high index of suspicion and expert interpretation of pathology may be necessary to secure the correct diagnosis.
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Affiliation(s)
- Nitish Mehta
- Department of Ophthalmology-Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
- Department of Ophthalmology, Ben Taub General Hospital, Houston, Texas
| | - Tahira Scholle
- Department of Ophthalmology-Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
- Department of Ophthalmology, Ben Taub General Hospital, Houston, Texas
| | - Patricia Chevez-Barrios
- Department of Ophthalmology-Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Houston, Texas; and
| | - Amy C Schefler
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Houston, Texas; and
- Retina Consultants of Texas and Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Christina Y Weng
- Department of Ophthalmology-Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
- Department of Ophthalmology, Ben Taub General Hospital, Houston, Texas
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8
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Moussa K, Begaj T, Ma K, Barrantes PC, Eliott D, Sobrin L. Systemic lymphoma masquerading as Vogt-Koyanagi-Harada syndrome: Report of a case with multimodal imaging and histopathology. Am J Ophthalmol Case Rep 2022; 27:101643. [PMID: 35800404 PMCID: PMC9254356 DOI: 10.1016/j.ajoc.2022.101643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/13/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To report a case of systemic diffuse large B cell lymphoma presenting with ocular manifestations and neurologic findings resembling Vogt-Koyanagi-Harada syndrome. Observations A 51-year-old Caucasian man presented with headache, ear pain, and blurry vision in both eyes. He was found to have bilateral exudative retinal detachments. After a short period of initial improvement with high dose systemic corticosteroid, his condition significantly worsened. An extensive work-up, including a kidney biopsy, led to a diagnosis of systemic diffuse large B cell lymphoma. He had excellent recovery following treatment with appropriate chemotherapy. Conclusions and Importance Systemic malignancy may present with ocular manifestations and may masquerade as another diagnosis. An unexpected clinical course may suggest an alternative diagnosis. A broad systemic work-up including an evaluation for malignancy should be considered for patients presenting with unexplained exam or systemic findings.
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Affiliation(s)
- Kareem Moussa
- Department of Ophthalmology & Vision Science, University of California, Davis, 4860 Y Street, Suite 2400, Sacramento, CA, 95817, USA
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA
- Corresponding author. Department of Ophthalmology & Vision Science, 4860 Y Street, Suite 2400, Sacramento, CA, 95817-2307, USA.
| | - Tedi Begaj
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA
- Associated Retinal Consultants, William Beaumont Hospital, 3555 W, Thirteen Mile Road, Suite LL-20, Royal Oak, MI, 48073, USA
| | - Kevin Ma
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Ct, Palo Alto, CA, 94303, USA
| | - Paula Cortes Barrantes
- David G. Cogan Laboratory of Ophthalmic Pathology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA
| | - Dean Eliott
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA
| | - Lucia Sobrin
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA
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Multimodal diagnostic imaging in primary vitreoretinal lymphoma. Int J Retina Vitreous 2022; 8:58. [PMID: 36028905 PMCID: PMC9419393 DOI: 10.1186/s40942-022-00405-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background Primary vitreoretinal lymphoma (PVRL) is an aggressive lymphoma that may present with protean features and represents a diagnostic challenge. Given that patients with PVRL are at high risk of CNS involvement with a high mortality and morbidity rate, prompt diagnosis is crucial to initiate treatment early in the disease course. A multimodality imaging approach including fundus photography, fundus autofluorescence (FAF), optical coherence tomography (OCT), fluorescein and indocyanine angiography, and electroretinography (ERG) can provide information to establish a diagnosis and provide objective measures for management. We review key findings seen via these imaging modalities in patients with PVRL. Observations Fundus photography can highlight commonly seen patterns of PVRL including vitritis, subretinal disease, retinal pigment epithelial (RPE) abnormalities, optic nerve edema, retinal detachment, and less typical retinitis-like lesions. FAF can identify characteristic patterns of hyper- and hypoautofluorescent signal abnormalities in the macula. Spectral-domain OCT will demonstrate vitreous cells, RPE nodularity, and hyperreflectivity of the outer retina. The presence of a hyper-reflective band in the subretinal space and infiltrates between the RPE and Bruch’s membrane can assist in distinguishing PVRL from choroidal lymphoma. Vertical hyperreflective columns (VHRLs) are another pertinent finding that may represent microinfiltrates of the tumor. OCT has proven to be a particularly useful modality in assessing the progress of treatment in PVRL. Fluorescein angiography can show RPE changes, which include granularity, late staining at the RPE level, and blockage. Indocyanine green angiography (ICGA) primarily shows hypocyanescence, which corresponds to PVRL lesions on fundus photography and may occur secondary to loss of RPE and choriocapillaris. Conclusion While PVRL remains a challenging disease to diagnose and follow, the use of a multimodality imaging approach may assist in establishing a diagnosis. Because of the anatomic spaces PVRL may affect, fundus photography, OCT, FAF, angiography, and ERG can identify key characteristics of the disease, differentiate PVRL from other diseases, and provide baseline information for targeted systemic and local therapies. Further assessment of anatomic and functional targets will aid our clinical application of multimodal imaging in the management of PVRL.
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Agarwal A, Aggarwal K, Katoch D, Invernizzi A, Arora A, Handa S, Sharma A, Sharma K, Gupta V. YELLOW SUBRETINAL PIGMENT EPITHELIUM DEPOSITS: A NOVEL SIGN IN OCULAR TUBERCULOSIS. Retin Cases Brief Rep 2022; 16:494-499. [PMID: 32541431 DOI: 10.1097/icb.0000000000001016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To describe a novel clinical and imaging finding in patients with tubercular posterior uveitis. METHODS A retrospective review of 3 cases presented at a tertiary referral eye centre in North India was performed between June 2016 and March 2019. All the patients had received an initial diagnosis of noninfective etiologies (sympathetic ophthalmia, necrotizing scleritis, and lymphoma). Fundus photography, fluorescein angiography, fundus autofluorescence, and enhanced-depth imaging optical coherence tomography were reviewed. RESULTS Three patients (all Asian Indian women: aged 18, 49, and 52 years) diagnosed with panuveitis were investigated for various etiologies based on the initial clinical suspicion. During the course of therapy, all the patients developed peripheral yellow subretinal pigment epithelium deposits (YSRPE) which appeared hypoautofluorescent on fundus autofluorescence and initially hypofluorescent with late hyperfluorescence on fluorescein angiography. The patients were subjected to detailed systemic evaluation and laboratory tests. All the patients showed acid-fast bacilli on invasive tissue biopsies. After initiation of antitubercular therapy, the lesions resolved in all eyes. CONCLUSION Yellow subretinal pigment epithelium deposits represent a novel and important diagnostic sign of tubercular posterior uveitis.
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Affiliation(s)
- Aniruddha Agarwal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kanika Aggarwal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deeksha Katoch
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Alessandro Invernizzi
- Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
- Faculty of Medicine and Health, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Atul Arora
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sabia Handa
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aman Sharma
- Division of Rheumatology, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India ; and
| | - Kusum Sharma
- Division of Mycobacteriology, Department of Microbiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Secondary vitreoretinal lymphoma with spontaneous regression. Am J Ophthalmol Case Rep 2022; 25:101357. [PMID: 35146209 PMCID: PMC8818703 DOI: 10.1016/j.ajoc.2022.101357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/20/2021] [Accepted: 01/22/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To report a patient with vitreoretinal lymphoma (VRL) secondary to systemic diffuse large B-cell lymphoma, who had two episodes of spontaneous regression. Observations An 80-year-old Nicaraguan male with a history of treated systemic diffuse large B-cell lymphoma presented with decreased vision in his right eye over one year. The patient was found to have subretinal lesions and moderate vitreous opacities in his right eye. Cytological analysis of vitreous confirmed B-cell lymphoma. Following his systemic work-up, spontaneous clinical improvement was noted. There were no vitreoretinal or systemic lymphoma recurrences during one year of follow-up until the patient had new onset decreased vision in the left eye. He was presumed to have a recurrence of VRL supported by optical coherence tomography findings. Repeat systemic workup was negative for reoccurrence and the ocular lesions resolved spontaneously over 4 weeks. Conclusions Spontaneous regression of intraocular lymphoma can rarely occur. Multimodal imaging has an essential role in diagnosing and monitoring recurrence of this disease.
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Takase H, Arai A, Iwasaki Y, Imai A, Nagao T, Kawagishi M, Ishida T, Mochizuki M. Challenges in the diagnosis and management of vitreoretinal lymphoma – Clinical and basic approaches. Prog Retin Eye Res 2022; 90:101053. [DOI: 10.1016/j.preteyeres.2022.101053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/30/2022] [Accepted: 02/06/2022] [Indexed: 12/13/2022]
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Anthony CL, Bavinger JC, Shantha JG, O'Keefe GD, Pearce WA, Voloschin A, Grossniklaus HE, Yeh S. Clinical outcomes following intravitreal methotrexate for primary vitreoretinal lymphoma. Int J Retina Vitreous 2021; 7:72. [PMID: 34863313 PMCID: PMC8645085 DOI: 10.1186/s40942-021-00346-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/19/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose To describe the visual acuity and anatomic outcomes of intravitreal methotrexate (MTX) for the treatment of primary vitreoretinal lymphoma (PVRL). Methods Single-center retrospective case series of patients with a diagnosis of PVRL treated with intravitreal MTX. Patient records were reviewed for demographic information, ocular exam findings, and treatment regimens including number of MTX injections. Clinical outcomes recorded included visual acuity (VA), time to partial (PR) or complete response (CR), disease-free survival, time to relapse, and any CNS progression. Results Ten eyes of 7 patients (4 male, 6 female) were reviewed. The mean age ± standard deviation (SD) was 70 ± 12 years. Five patients had prior or concomitant diagnosis of primary CNS lymphoma with a history of systemic chemotherapy including MTX. Three eyes (30%) exhibited isolated vitreous involvement, four (40%) had subretinal lesions, and three (30%) presented with both vitreous and subretinal disease. Mean initial logMAR VA was 0.38 ± 0.52 (Snellen visual equivalent 20/50), while mean final logMAR VA ± SD was 0.34 ± 0.27 (Snellen visual equivalent 20/40) with a mean follow-up time of 26 months (Range, 3–49 months). Patients received an average of 6 intravitreal MTX injections (Range 1–10) over the course of treatment. Two patients received concomitant systemic chemotherapy. Mean time to either PR or CR was 57 days, and 6 eyes (60%) exhibited regression with no relapse after local treatment. For the 4 eyes that eventually relapsed, the mean time ± SD to first relapse was 193 days ± 155 days, and one eye experienced a second relapse. Two of 3 patients with subretinal disease showed complete regression with extended follow-up of 1 and 4 years following treatment with less than 3 doses of intravitreal MTX. One patient with PVRL developed CNS lymphoma during the study period. VA remained stable overall between the initial treatment visit, 3, 6, and 12-months (P > 0.05 for paired comparisons of VA over time). Conclusions Intravitreal methotrexate was well-tolerated and led to local disease response in the majority of patients at approximately 2 months after initiation of treatment of intraocular lymphoma. Further studies on the efficacy of intravitreal treatment alone versus combined systemic and intravitreal treatment are warranted.
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Affiliation(s)
- Casey L Anthony
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - J Clay Bavinger
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jessica G Shantha
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Ghazala D O'Keefe
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - William A Pearce
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Alfredo Voloschin
- Department of Medicine, Hematology and Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Hans E Grossniklaus
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven Yeh
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA. .,Department of Ophthalmology, Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth St., Omaha, NE, 68106, USA.
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Hassan M, Halim MS, Afridi R, Nguyen NV, Nguyen QD, Sepah YJ. Evaluating optical coherence tomography (OCT) findings as potential biomarkers in central nervous system (CNS) lymphoma with or without ocular involvement. Int J Retina Vitreous 2021; 7:70. [PMID: 34819169 PMCID: PMC8611969 DOI: 10.1186/s40942-021-00345-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate spectral domain optical coherence tomography (SD-OCT) findings as biomarkers in primary central nervous system lymphoma (PCNSL) with or without ocular involvement. METHODS This study was a cross-sectional study and patients with a confirmed diagnosis of PCNSL with or without ocular involvement were included. Patient cohort finder tool was used to identify patients with lymphoma using ICD-10 codes (C82-C88), from January 2004 to October 2017. A total of 14,820 patients were identified. Procedure code (92134) for optical coherence tomography (OCT) was then applied to identify patients who had underdone OCT imaging at ophthalmology clinic. Clinic charts of 460 patients with lymphoma and available OCT were reviewed to identify patients with confirmed diagnosis of PCNSL and divided into two groups (Group 1: with and Group 2: without ocular involvement). OCT scans of patients in both study groups were analyzed for the presence of (1) Hyperreflective deposits in choroid, retinal pigment epithelium (RPE), outer and inner retina; (2) RPE thickening; (3) Vitreous debris; (4) Intraretinal fluid; (5) Ellipsoid zone disruption by masked graders. Chi-square was used to analyze the difference between the groups. RESULTS Twenty-two eyes (11 patients) with PCNSL were included this study (Group 1: 6 eyes and Group 2: 16 eyes). Mean age of subjects was 65 years. Five patients (45.45%) were female. There was no statistically significant difference between the groups for the presence of hyperreflective deposits in choroid, RPE, outer and inner retina, and presence of RPE thickening, intraretinal fluid, and ellipsoid zone disruption. Vitreous debris was found more commonly in group 1 subjects (83%) than group 2 (31.25%) (p = 0.029). All subjects in both groups showed hyperreflective deposits in the RPE demonstrating RPE infiltration. However, RPE thickening was noted only in 3 patients (Group1: 1 and Group2: 2). CONCLUSIONS OCT finding of hyperreflective deposits present in eyes with lymphoma secondary to PCNSL are also observed in eyes with PCNSL without ocular disease. However, the vitreous deposits are more commonly found in eyes with ocular disease. These hyperreflective deposits can serve as biomarkers for early detection of ocular involvement by PCNSL.
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Affiliation(s)
- Muhammad Hassan
- Byers Eye Institute, Stanford University, 2370 Watson Court, Palo Alto, CA, 94303, USA
| | - Muhammad Sohail Halim
- Byers Eye Institute, Stanford University, 2370 Watson Court, Palo Alto, CA, 94303, USA.,Ocular Imaging Research and Reading Center, Menlo Park, CA, USA
| | - Rubbia Afridi
- Ocular Imaging Research and Reading Center, Menlo Park, CA, USA
| | - Nam V Nguyen
- Byers Eye Institute, Stanford University, 2370 Watson Court, Palo Alto, CA, 94303, USA.,Ocular Imaging Research and Reading Center, Menlo Park, CA, USA
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, 2370 Watson Court, Palo Alto, CA, 94303, USA
| | - Yasir J Sepah
- Byers Eye Institute, Stanford University, 2370 Watson Court, Palo Alto, CA, 94303, USA.
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15
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Rali A, Xu LT, Craven C, Cohen JB, Yeh S, Grossniklaus HE, O'Keefe GD. Diagnostic retinal biopsy in the management of secondary non-CNS vitreoretinal lymphoma masquerading as viral retinitis: a case report. Int J Retina Vitreous 2021; 7:58. [PMID: 34635180 PMCID: PMC8507152 DOI: 10.1186/s40942-021-00327-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/12/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Intraocular lymphoma accounts for fewer than 1% of intraocular tumors. When the posterior segment is involved, it can be further classified as vitreoretinal or choroidal lymphoma. Vitreoretinal lymphoma (VRL) can rarely masquerade as an infectious retinitis making diagnosis and management challenging. RESULTS A 73-year-old woman with a history of non-central nervous system (CNS) involving diffuse large B-cell lymphoma (DLBCL) was referred for worsening blurry vision-visual acuity of count figures at 2 ft-in her right eye for 8 months. Dilated fundus examination of the right eye was significant for retinal whitening and dot-blot hemorrhages, which was concerning for a viral retinitis and guided initial management. Secondary intraocular lymphoma was also considered. The retinal disease continued to progress despite intravitreal and systemic antiviral therapy, and a diagnostic vitrectomy was inconclusive. A retinal biopsy was then performed, which showed DLBCL, confirming a diagnosis of secondary VRL. Three subsequent treatments with intravitreal methotrexate led to regression of the VRL. CONCLUSIONS Our case highlights the utility of a retinal biopsy after an inconclusive diagnostic vitrectomy in a challenging scenario of VRL to establish a diagnosis and initiate successful treatment. A multidisciplinary team of providers was essential for diagnosis, comprehensive workup, medical and surgical management of the patient.
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Affiliation(s)
- Aditya Rali
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Lucy T Xu
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Caroline Craven
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jonathon B Cohen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven Yeh
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
- Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Hans E Grossniklaus
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Ghazala D O'Keefe
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA.
- Uveitis and Retinal Disease, Emory Eye Center, Emory University School of Medicine, Atlanta, USA.
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16
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Abdi F, Mohammadi SS, Falavarjani KG. Intravitreal Methotrexate. J Ophthalmic Vis Res 2021; 16:657-669. [PMID: 34840688 PMCID: PMC8593537 DOI: 10.18502/jovr.v16i4.9756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/17/2021] [Indexed: 11/24/2022] Open
Abstract
Intravitreal methotrexate (MTX) has been proven to be an effective treatment for various intraocular diseases. In this article, a comprehensive review was performed on intravitreal applications of methotrexate. Different aspects of the administration of intravitreal MTX for various clinical conditions such as intraocular tumors, proliferative vitreoretinopathy, diabetic retinopathy, age-related macular degeneration, and uveitis were reviewed and the adverse effects of intravitreal injection of MTX were discussed. The most common indications are intraocular lymphoma and uveitis. Other applications remain challenging and more studies are needed to establish the role of intravitreal MTX in the management of ocular diseases.
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Affiliation(s)
- Fatemeh Abdi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - S. Saeed Mohammadi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Khalil Ghasemi Falavarjani
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
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Abstract
PURPOSE To determine the association between vitreoretinal lymphoma and systemic lymphoma (SL). METHODS Single-center retrospective review of medical records. RESULTS Of 95 patients with vitreoretinal lymphoma, 18 (19%) had associated SL (SL group) and 77 (81%) were not associated with SL (no SL group). The most common sites of SL were skin (n = 5), testis (n = 2), liver and breast (n = 2), and others (n = 9). A comparison (SL group vs. [vs.] no SL group) revealed no difference in demographic or ocular findings at initial visit. In the SL group, SL occurred before the onset of ocular symptoms in 14 (78%) patients with mean interval of 86 months (median 61, range 5-286 months) or after ocular symptoms in 4 (22%) patients with mean interval of 19 months (median 12, range 7-44 months). A comparison revealed no difference in overall frequency of pre-existing or eventual central nervous SL (50% vs. 53%, P = 0.99); however, the SL group demonstrated central nervous SL more often after onset of ocular symptoms (78% vs. 17%, P = 0.001). A comparison found no difference in treatment methods, response of vitreoretinal lymphoma to treatment, final visual outcome, or death rate. CONCLUSION We found 19% of patients with vitreoretinal lymphoma demonstrate related SL, and there was no difference in demographics, clinical features, or response to treatment, compared to those not associated with SL.
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18
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Anthony CL, Bavinger JC, Yeh S. Advances in the Diagnosis and Management of Acute Retinal Necrosis. ANNALS OF EYE SCIENCE 2020; 5:28. [PMID: 33381683 PMCID: PMC7771653 DOI: 10.21037/aes-2019-dmu-09] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Acute retinal necrosis (ARN) is a devastating syndrome characterized by panuveitis, retinal necrosis, and a high rate of retinal detachment that may result in poor visual outcomes if not promptly diagnosed and treated. ARN is most commonly caused by viruses with the herpesvirus family. Etiologies include varicella-zoster virus, herpes simplex virus, and cytomegalovirus, and may be promptly diagnosed by polymerase chain reaction testing of aqueous or vitreous fluid. The true incidence of ARN is not known due to its rarity; as a result, clinical treatment is often guided by retrospective case series, case reports, and expert opinion. Standard of care has evolved over time but currently includes a combination of systemic and intravitreal antiviral in conjunction with topical or oral steroids and surgical therapy as needed. Combination therapy may reduce the rate of severe vision loss and increase the rate of visual acuity gain, although further studies are needed in this area. In particular for patients with mild to moderate disease, combination therapy may reduce the rate of retinal detachment. Adjunctive therapies including oral corticosteroid and prophylactic laser barricade are incompletely studied, but corticosteroid in particular, may reduce inflammation, which also is involved in the severe disease pathogenesis observed in ARN. This review discusses the advances in diagnosis and treatment of ARN, including management with combination antiviral medication and surgical interventions.
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Affiliation(s)
| | | | - Steven Yeh
- Department of Ophthalmology, Emory Eye Center, Atlanta, GA
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19
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20
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Marchese A, Agarwal A, Miserocchi E, Giuffrè C, Bandello F, Modorati G, Prakash G, Gupta N, Bosello F, Sharma SP, Gupta V. Features of Retinitis-like Lesions in Vitreoretinal Lymphoma. Ocul Immunol Inflamm 2019; 29:440-447. [PMID: 31567000 DOI: 10.1080/09273948.2019.1648835] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To describe the distinguishing features of retinitis-like lesions seen in vitreoretinal lymphoma (VRL) from viral and toxoplasma retinitis.Methods: In this multicenter, retrospective study, we reviewed charts and imaging of consecutive patients with VRL. The associated features and the characteristics of retinitis-like lesions were assessed and compared with those of viral and toxoplasmic retinochoroiditis. Primary outcome measures were the unique features of VRL retinitis-like lesions.Results: Out of 76 eyes of 38 patients with VRL, retinitis-like lesions were identified in 6 eyes and confirmed on OCT. Distinctive features of VRL retinitis-like lesions were massive retinal thickening, associated sub-retinal pigment epithelium infiltrates and partial restoration of retinal layers after specific therapy.Conclusion: VRL can present with retinitis-like lesions that have distinctive OCT features on presentation as well as healing that can help to differentiate them from other lookalike etiologies and can guide further diagnostic and therapeutic interventions.
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Affiliation(s)
- Alessandro Marchese
- Department of Ophthalmology, San Raffaele Hospital, University Vita-Salute San Raffaele, Milan, Italy
| | - Aniruddha Agarwal
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Elisabetta Miserocchi
- Department of Ophthalmology, San Raffaele Hospital, University Vita-Salute San Raffaele, Milan, Italy
| | - Chiara Giuffrè
- Department of Ophthalmology, San Raffaele Hospital, University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, San Raffaele Hospital, University Vita-Salute San Raffaele, Milan, Italy
| | - Giulio Modorati
- Department of Ophthalmology, San Raffaele Hospital, University Vita-Salute San Raffaele, Milan, Italy
| | - Gaurav Prakash
- Department of Hemato-Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynecological Pathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Francesca Bosello
- Department of Ophthalmology, San Raffaele Hospital, University Vita-Salute San Raffaele, Milan, Italy
| | - Surya Prakash Sharma
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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21
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Reddy V, Winslow R, Cao JH, Robertson ZM, Chen B, Ufret-Vincenty RL. Vitreoretinal lymphoma, secondary to non-CNS systemic lymphoma, masquerading as an infectious retinitis. Am J Ophthalmol Case Rep 2019; 16:100545. [PMID: 31468000 PMCID: PMC6711862 DOI: 10.1016/j.ajoc.2019.100545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 04/08/2019] [Accepted: 08/13/2019] [Indexed: 12/28/2022] Open
Abstract
Purpose To report an atypical case of vitreoretinal lymphoma, secondary to non-central nervous system (non-CNS) systemic lymphoma, masquerading as an infectious retinitis. Observations A 76-year-old female with a history of cecal diffuse large B-cell lymphoma with two prior occurrences of posterior segment ocular involvement presented with a complaint of blurry vision in the right eye. Exam findings were significant for large areas of retinal whitening and retinal hemorrhages in the absence of choroidal lesions or significant vitritis. The clinical suspicion of an infectious retinitis, was supported by a presumptive immunosuppressive state secondary to her recent treatment (within 1 month) with both intravitreal and systemic rituximab plus high-dose methotrexate. Aggressive treatment with intravitreal and systemic antivirals and antibiotics was initiated. However, polymerase chain reaction (PCR) testing of aqueous fluid was negative for cytomegalovirus (CMV), herpes simplex virus, herpes zoster virus and toxoplasma, and her condition continued to worsen, so suspicion was raised for a masquerading recurrent malignancy. She was treated empirically with serial intravitreal injections of methotrexate and showed dramatic clinical improvement. A subsequent relapse occurred that responded rapidly to intravitreal methotrexate in the absence of antiviral/antibiotics. Conclusion It is important for clinicians to be aware of atypical presentations of vitreoretinal lymphoma. This case emphasizes the fact that secondary ocular lymphoma after systemic lymphoma can have a vitreoretinal presentation rather than the more common choroidal involvement. Furthermore, it shows that recurrences of this disease in the same patient can have very different manifestations, including an appearance indistinguishable from a viral retinitis.
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Affiliation(s)
- Varun Reddy
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, 75390-9057, USA
| | - Richard Winslow
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, 75390-9057, USA
| | - Jennifer H Cao
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, 75390-9057, USA
| | - Zachary M Robertson
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, 75390-9057, USA
| | - Bo Chen
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, 75390-9057, USA.,Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, China
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22
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Fan KC, Tran KD, Harbour JW, Dubovy SA, Patel NA, Albini TA. Vitreoretinal lymphoma followed by systemic diffuse large B cell lymphoma. J Ophthalmic Inflamm Infect 2019; 9:11. [PMID: 31183567 PMCID: PMC6557958 DOI: 10.1186/s12348-019-0177-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 05/21/2019] [Indexed: 11/19/2022] Open
Abstract
Vitreoretinal lymphoma as the presenting diagnosis in association with a systemic lymphoma without central nervous system involvement is exceedingly rare, and the classification of this condition is not well-established. Here, we describe a patient with intermittent blurry vision in the left eye for 2 years in the setting of a recent incidental diagnosis of diffuse large B cell lymphoma from an axillary lymph node biopsy. The diagnosis of panuveitis with an extensive exudative retinal detachment was made. The patient was treated with pars plana vitrectomy as well as systemic chemotherapy, intrathecal methotrexate, intravitreal methotrexate, and intravitreal rituximab with good post-operative outcomes.
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Affiliation(s)
- Kenneth C Fan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St., Miami, FL, 33136, USA
| | - Kimberly D Tran
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St., Miami, FL, 33136, USA
| | - J William Harbour
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St., Miami, FL, 33136, USA
| | - Sander A Dubovy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St., Miami, FL, 33136, USA
| | - Nimesh A Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St., Miami, FL, 33136, USA
| | - Thomas A Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St., Miami, FL, 33136, USA.
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