Ocular manifestations of systemic lymphoma.

PURPOSE: A comprehensive understanding of the ocular presentations of systemic lymphoma (SL) is needed for early recognition and treatment to improve outcomes.

DESIGN

A retrospective study.

METHODS

The ocular manifestations of 17 patients with SL were retrospectively summarized.

RESULTS

Among 17 SL patients, 12 (21 eyes) presented with secondary vitreoretinal lymphoma (SVRL) and five (8 eyes) presented with viral retinitis. Among those with SVRL, 16 eyes (76.2%) exhibited only vitreoretinal involvement, three eyes (14.3%) had both choroid and vitreoretinal involvement, and two eyes (9.5%) showed lacrimal gland and vitreoretinal involvement. Ocular symptoms occurred at a median interval of 63 months (range: 4-220 months) after SL diagnosis. Ocular manifestations included keratic precipitates in 10 eyes (47.6%), anterior chamber cells in 10 eyes (47.6%), vitreous cells in 18 eyes (85.7%), subretinal infiltrates in six eyes (28.6%), optic nerve involvement in three eyes (14.3%), neovascular glaucoma in five eyes (23.8%), and ciliary body/choroidal involvement in three eyes (14.3%). Patients received intravitreal methotrexate injections and systemic chemotherapy. The 3-year survival rate was 47.5%. Viral retinitis manifested as vitritis, peripheral retinal focal necrosis, and retinal vasculitis, and among those five patients, the median interval from SL diagnosis to ocular involvement was 15 months (range: 9-28 months). These patients received antiviral therapy and intravitreal ganciclovir injections.

CONCLUSIONS

SVRL and viral retinitis are two ocular manifestations of SL. Vitreous biopsy and PCR testing are valuable for distinguishing between them. Our findings support the importance of long-term ocular surveillance in patients with SL.