1. Centre of Ophthalmology University of Tuebingen, Germany
Intraocular Lymphoma
Manfred Zierhut
Centre of Ophthalmology
University of Tuebingen, Germany

2. Ocular History 46 year old woman 3-2000: OD blurred vision
1999: OS „similar problems“

3. April 2000: First Presentation
VA: OD 20/20, OS 20/25
Mild AC cell infiltration
Fundus:
Multifocal chorioretinitis
Pigment atrophy

6. April 2000: First Presentation
ESR: 59/100 (known since 1995)
Prednisolone 75 mg
Improvement

7. June 2000 to February 2001
6-2000: Recurrence with retinal infiltration
8-2000:
OD: CME: VA 20/32
Prednisolone: minimal improvement
9-2000: Optic disc edema with bleeding
: Azathioprine 150 mg
2-2001: inactive, VA 20/20

10. May 2001 Peripheral CNV with subretinal bleeding
Serpiginous chorioretinitis?

13. July 2001 to August 2001 7-2001: Pigmentepithel detachment
Exsudative retinal detachment
MRI of the brain: negative
Steroid induced diabetes
8-2001:
Cyclosporine A: bleeding in resorption

16. September to October 2001 9-2001: OD: 20/100, OS: 20/32
Massive vitreous cells :
OD: 20/400
Diagnostic ppV: no lymphoma cells

19. Diagnosis after choroidal Biopsy
B-cell non-Hodgkin lymphoma
Positive for CD20, MIB1
Negative for CD3, CD138, c-kit, HMB45, κ-, and λ
Bone marrow: negative

20. Problems Ocular disease with the highest 5-year letality
Increasing incidence
Diagnosis often late
Negative vitreous biopsy does not exclude NHL
Therapy not clear when CNS-manifestation is missing

21. Case Report: Treatment
Intravenous Methotrexate
: 1. course (7.52 g)
: 2. and 3. course
: 4. and 5. course
1-2002: 6. course

22. Follow-up 11-2001: VA: 20/200, 20/40 Remaining bleedings
Resorption of the infiltration
Scarring :
No signs of recurrence or scarring
VA: 20/200, 20/20

25. Final Diagnosis Non-Hodgkin lymphoma without CNS involvement
Untypical clinical manifestation immitating
Serpigninous
Multifocal chorioretinitis
With development of subretinal neovascularisation membrane
Good response of the eye to i.v. MTX

26. Conclusion Clinic of intraocular lymphoma highly variable
Can mimic multiple other uveitis disorders
When diagnostic ppV negative but still suggestive for lymphoma: retinal biopsy
In this patient i.v. MTX (3 g/m2) was effective as monotherapy