PURPOSE: Intraocular lymphoma can be divided into primary and secondary usually involving B-cell lymphoma. Intraocular T-cell lymphoma is mostly secondary lymphoma while primary intraocular T-cell lymphoma is extremely rare. We report a case of primary T-cell lymphoma. CASE SUMMARY: A 62-year-old male without any systemic disease presented with a floater in the right eye. A fundus examination showed multiple whitish retinal infiltrations in the right eye. Intraocular lymphoma was suspected, and systemic examination was performed, but all results were normal. During steroid treatment, previous lesions were enlarged, new lesions developed, and a diagnosis of primary T-cell lymphoma was made by diagnostic vitrectomy. Consecutive intravitreal injections of methotrexate were performed. After eight injections, the vitreous and retinal lesions improved but we decided to terminate the injections due to corneal epitheliopathy. The corneal epitheliopathy was recovered and the patient is currently undergoing periodic follow-ups without progression of the lesion. CONCLUSIONS: Although intraocular T-cell lymphoma is a rare condition, this primary T-cell type should be considered when an intraocular lymphoma lesion is suspected.
Diagnosis ; Follow-Up Studies ; Humans ; Intraocular Lymphoma ; Intravitreal Injections ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, T-Cell ; Male ; Methotrexate ; Middle Aged ; Retinaldehyde ; T-Lymphocytes ; Vitrectomy

PURPOSE: To report a case of secondary choroidal lymphoma. CASE SUMMARY: A 57-year-old female presented at our clinic with decreased vision in her right eye 1 month in duration. Slit-lamp examination showed vitreous cells in the right eye. Fundus examination of the right eye revealed an elevated yellowish mass-like lesion at the temporal area and multifocal yellowish patches at the choroidal level. The clinical impression was intraocular lymphoma. We performed diagnostic vitrectomy, but the result was negative. A systemic evaluation revealed enlarged cervical lymph nodes and lymph node biopsy showed diffuse large B-cell lymphoma. The patient was diagnosed as secondary choroidal lymphoma associated with systemic lymphoma and was treated with systemic chemotherapy and 4 injections of intravitreal methotrexate. The patient is scheduled for regular follow-ups. CONCLUSIONS: Choroidal mass may be the initial presenting sign of systemic lymphoma, and an extensive systemic evaluation should be performed.
Biopsy ; Choroid* ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Intraocular Lymphoma ; Lymph Nodes ; Lymphoma* ; Lymphoma, B-Cell ; Methotrexate ; Middle Aged ; Vitrectomy

BACKGROUND: Intraocular lymphoma (IOL) is a rare malignant lymphoma that most closely resembles a diffuse large B-cell lymphoma, and it is a subtype of primary central nervous system lymphoma (PCNSL). IOL is located inside the eye in the retina, uvea, and/or optic nerve. We retrospectively analyzed IOL patient data to identify treatment patterns and survival rates in Korea. METHODS: Cytological confirmation for a diagnosis of IOL was performed for all patients. The clinical data collected from medical records included Ann Arbor stage, International Prognostic Index, performance status, date of diagnosis, treatment modality and response, date of relapse, and date of last follow-up. RESULTS: Twenty patients who were diagnosed with IOL, between December 2007 and June 2014 at multiple centers in Korea, were included in the analysis. Four patients were diagnosed with IOL alone, not involving the CNS. Two patients with isolated IOL later developed PCNSL. Nine patients developed CNS lesions before the onset of ocular lymphoma. Five patients had simultaneous onset in the eye and CNS. Twelve patients were treated by intravitreal injection of methotrexate for IOL. The median progression-free survival (PFS) for patients was 19.7 months (95% CI, 8.7-30.7 mo). The estimated 3-year overall survival (OS) for all patients was 75.1%. CONCLUSION: Treatment for IOL patients included radiotherapy and intraocular chemotherapy. IOL patients showed favorable PFS and OS. These patients would require long-term follow-up to identify relapse and adverse effects of radiotherapy or intraocular chemotherapy.
Central Nervous System ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Intraocular Lymphoma* ; Intravitreal Injections ; Korea* ; Lymphoma* ; Lymphoma, B-Cell ; Medical Records ; Methotrexate ; Optic Nerve ; Radiotherapy ; Recurrence ; Retina ; Retrospective Studies ; Survival Rate ; Uvea

The purpose of the study is to minimize the incidence of glaucoma and ocular hypertension caused by using corticosteroids during induction chemotherapy for acute lymphoblastic leukemia in children. We have periodically observed the intraocular pressure and the variation of C / D ratio of two 7 years old boys with chemotherapy in our pediatric department. We observed the increase in intraocular pressure using applanation tonometer, and we managed by beta- blockers, carbonic anhydrase inhibitor and etc. Increased intraocular pressure has been normalized after chemotherapy. The frequency of occurrence of the ocular hypertension and glaucoma can be controlled with the quantity of corticosteroids used.
Adrenal Cortex Hormones ; Carbonic Anhydrases ; Child ; Drug Therapy ; Glaucoma* ; Humans ; Incidence ; Induction Chemotherapy* ; Intraocular Pressure ; Leukemia ; Ocular Hypertension ; Precursor Cell Lymphoblastic Leukemia-Lymphoma*

PURPOSE: To compare surgically induced corneal astigmatism following trabeculectomy versus deep sclerectomy and collagen implant (DSCI). METHODS: 37 consecutive eyes of 28 patients having glaucoma surgeries for uncontrolled open-angle glaucoma were retrospectively analyzed. 16 eyes had trabeculectomy and 21 eyes had DSCI. Visual acuity, intraocular pressure (IOP) and autorefractokeratometry of both groups were evaluated preoperatively and 1, 7 days, 1, 3, 6, 12 months postoperatively. Postoperative changes in corneal astigmatism were evaluated using vector analysis. RESULTS: Mean age was 51.63 +/- 12.73 years in the trabeculectomy group and 39.95 +/- 15.09 years in the DSCI group and differed between groups (p = 0.015). Visual acuity was significantly decreased after surgery compared with preoperative values and was improved slowly in both groups. Intraocular pressure was lower in the trabeculectomy group than in the DSCI group at postoperatively 1 and 6 months (p = 0.046 and 0.029, respectively). There was no significant difference in surgically induced corneal astigmatisms (SIA) between both surgeries, which decreased over time in the group with stable postoperative IOP. They showed with-the-rule astigmatism immediate postoperatively. The DSCI group with MMC showed less SIA than the group without MMC. CONCLUSIONS: Surgically induced astigmatisms following trabeculectomy and deep sclerectomy with collagen implant were not differ significantly between two surgeries.
Astigmatism ; B-Lymphocytes ; Collagen ; Eye ; Glaucoma ; Glaucoma, Open-Angle ; Humans ; Intraocular Pressure ; Lymphoma, B-Cell ; Mitomycin ; Orbit ; Retrospective Studies ; Sinusitis ; Trabeculectomy ; Visual Acuity

PURPOSE: To report a case where bilateral malignant retrobulbar lymphoma was diagnosed after repetitive intraocular lens dislocation to the anterior chamber. CASE SUMMARY: An 85-year-old male with a history of stroke who had undergone cataract surgery 10 years ago at another hospital presented with repeated intraocular lens (IOL) dislocations of both eyes into the anterior chamber. He had previously undergone IOL scleral fixation once in his left eye and twice in his right eye, but IOL dislocation was still repeatedly occurring. The best-corrected visual acuity was 0.4 in both eyes. Hertel exophthalmetry was 20 mm in his right eye and 18 mm in his left eye. Painless limitation of motion at supraduction was observed in the right eye. Funduscopy showed newly appeared choroidal folding in the right eye, so orbital computed tomography (CT) with contrast was performed. The CT scans showed bilateral homogenously enhancing retrobulbar masses. Biopsy of the masses showed a MALToma. After radiation therapy, the choroidal folds resolved and exophthalmetry improved to 10 mm in both eyes. No additional IOL dislocation occurred. During 2.5 years of follow-up, there was no evidence of recurrence or distant metastasis of the MALToma. CONCLUSIONS: Orbital lymphomas can cause lid edema, exophthalmos, strabismus, and diplopia, and can be diagnosed with imaging modalities such as CT. Final diagnosis involves biopsy and radiation therapy or chemotherapy. If IOL dislocation occurs repeatedly, it may result from an increase in retrobulbar pressure, and concurrent choroidal folding using funduscopy is strongly recommended for imaging to check for the presence of retrobulbar masses.
Aged, 80 and over ; Anterior Chamber ; Biopsy ; Cataract ; Choroid ; Diagnosis ; Diplopia ; Dislocations* ; Drug Therapy ; Edema ; Exophthalmos ; Follow-Up Studies ; Humans ; Lenses, Intraocular* ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Male ; Neoplasm Metastasis ; Orbit ; Recurrence ; Strabismus ; Stroke ; Tomography, X-Ray Computed ; Visual Acuity

PURPOSE: To report one case of primary central nervous system lymphoma with ocular involvement confirmed by pars plana vitrectomy. METHODS: A 52-year-old healthy man visited our hospital complaining of progressive dysarthria, memory impairment, and chronic headache. Brain CT scans and MRI scans revealed a brain tumor in the left basal ganglia and the frontal lobe. Stereotactic biopsy of the tumor showed a large diffuse B-cell type malignant lymphoma. Three months later, he presented with decreased vision and sensation of floaters in the right eye. Funduscopic examination of the right eye revealed a vitreous opacity peripherally. He underwent pars plana vitrectomy and vitreous biopsy to rule out ocular involvement of lymphoma. Smears from the cytospin of the specimen prepared from vitrectomy in the right eye showed a greater number of large, pleomorphic lymphoid cells. Flow cytometric immunophenotyping showed a clonal population of CD 20 which was conclusive for infiltration with B-cell lymphoma. RESULTS: The patient underwent treatment with radiotherapy to the brain and the right eye in combination with systemic and intrathecal chemotherapy. After five cycles of chemotherapy and radiotherapy, the brain mass disappeared, the neurological symptoms were improved, and the visual acuity of the right eye increased.
B-Lymphocytes ; Basal Ganglia ; Biopsy ; Brain ; Brain Neoplasms ; Central Nervous System* ; Drug Therapy ; Dysarthria ; Frontal Lobe ; Headache Disorders ; Humans ; Immunophenotyping ; Intraocular Lymphoma ; Lymphocytes ; Lymphoma* ; Lymphoma, B-Cell ; Magnetic Resonance Imaging ; Memory ; Middle Aged ; Radiotherapy ; Sensation ; Tomography, X-Ray Computed ; Visual Acuity ; Vitrectomy

PURPOSE: To report the case of an isolated abscess in an extraocular muscle. CASE SUMMARY: We report a case of an isolated abscess in an extraocular muscle in a patient who was treated with systemic chemotherapy for precursor B lymphoblastic leukemia. A 54-year-old female who had undergone systemic chemotherapy for precursor B lymphoblastic leukemia presented with right ocular pain and limited eye movements. On ophthalmic examination, she had elevated intraocular pressure (IOP) and limited upward and downward gaze. MRI (magnetic resonance imaging) examination revealed an isolated abscess in right inferior rectus muscle. Although the patient was treated with empirical intravenous antibiotics and IOP-lowering agents, the size of the abscess increased, as confirmed by MRI findings. Therefore, we performed a pus drainage procedure by the transconjunctival approach. We were not able to find any residual abscess lesions on CT scans 3 months postoperatively. The patient's ocular pain disappeared and the limited eye movements improved significantly 6 months postoperatively. CONCLUSIONS: There have been no case reports of an isolated abscess in an extraocular muscle in Korea. For immunocompromised patients unresponsive to systemic empirical antibiotic treatment, an early pus drainage procedure by the transconjunctival approach may be a useful and effective therapeutic method in the management of an idiopathic isolated abscess in an extraocular muscle.
Abscess* ; Anti-Bacterial Agents ; Drainage ; Drug Therapy ; Eye Movements ; Female ; Humans ; Immunocompromised Host ; Intraocular Pressure ; Korea ; Magnetic Resonance Imaging ; Middle Aged ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Suppuration ; Tomography, X-Ray Computed

PURPOSE: To report a rare case of lymphocytic hypophysitis in a 31-year-old woman who presented with gradually progressive bilateral visual loss during the third trimester of pregnancy. METHODS: Ophthalmologic examination revealed best corrected visual acuity of 0.02 OD and counting fingers at 20 cm OS. Pupil examination revealed no relative afferent pupillary defect in either eye and intraocular pressure was normal in both eyes. A visual field test revealed nearly total visual defect sparing superotemporal area OD and total defect OS. An MRI of the head was performed. RESULTS: At the time of transsphenoidal surgery following the patient's delivery, a frozen biopsy of the lesion revealed diffuse lymphocytic infilteration and fibrosis of the pituitary gland consistent with the diagnosis of lymphocytic hypophysitis. Postoperatively the patient was treated for hypopituitarism. At 5 weeks postoperative, her best corrected visual acuity was 1.0 OU, and visual field defects resolved in both eyes. On follow-up by telephone for postoperative 7 months, the patient remained visually asymptomatic. CONCLUSIONS: The clinical presentation of lymphocytic hypophysitis may mimic pituitary adenoma, lymphoma, germinoma, and histiocytosis. The diagnosis should be suspected in any pregnant or postpartum patient with an intrasellar or suprasellar mass.
Adult ; Biopsy ; Diagnosis ; Female ; Fibrosis ; Fingers ; Follow-Up Studies ; Germinoma ; Head ; Histiocytosis ; Humans ; Hypopituitarism ; Intraocular Pressure ; Lymphoma ; Magnetic Resonance Imaging ; Pituitary Gland ; Pituitary Neoplasms ; Postpartum Period ; Pregnancy Trimester, Third ; Pregnancy* ; Pupil ; Pupil Disorders ; Telephone ; Visual Acuity ; Visual Field Tests ; Visual Fields