Intraocular Involvement of a Nasal Natural Killer T-Cell Lymphoma: A Case Report

Herein, we report a case of nasal natural killer T-cell lymphoma (NKTL) with intraocular involvement. A 57-year-old woman was referred due to a three-day history of photophobia and diplopia in the left eye. One-month previously, she was diagnosed with nasal NKTL of the right nasal cavity. Ophthalmic examination revealed conjunctival injection and ptosis. The left pupil was fully dilated and non-reactive to light. Ocular motion was restricted on left-upper gaze. Five days later, anterior uveitis developed and persisted despite topical steroid treatment. An orbital magnetic resonance imaging was without specific findings, however, ophthalmoplegia, vitreous opacity, and an iris mass were observed. A diagnostic anterior chamber aspiration was performed. Aqueous humor aspiration revealed 35% morphologically atypical lymphocytes. After an intravitreal triamcinolone injection, radiotherapy and chemotherapy were administered; this resolved the uveitis and iris mass. When refractory uveitis or orbital pseudotumor occurs in patients with nasal NKTL, ocular and orbital involvement of the NKTL should be considered.

The Use of Ultrasonography for Detection of Retinal Detachment in Patients with Vitreous Hemorrhage

PURPOSE: This study aimed to determine the accuracy of ultrasonography (US) in detecting retinal detachment in vitreous hemorrhage (V-HEMO). METHODS: A chart review of 81 patients (86 eyes) who have undergone pars plana vitrectomy in the treatment of V-HEMO between June 1996 and June 2004 was done. RESULTS: The most common cause of vitreous hemorrhaging was proliferative diabetic retinopathy (PDR) (39 eyes, 45.3%), followed by ocular trauma (22 eyes, 25.6%). the correct anatomic position of the retina was identified with US in 72 of 86 eyes (83.7%), with eight false positives (9.3%) and six false negatives(7.9%). The sensitivity of US was calculated as 73% and specificity was 88%. US within the PDR group correctly identified 29 of 39 eyes (74.4%), and had a sensitivity of 62% and a specificity of 81%. US within the non-PDR group correctly identified 43 of 47 eyes (91.5%), and had a sensitivity of 89% and a specificity of 92%. CONCLUSIONS: It has been reported that US is an effective diagnostic tool in patients with media opacity, however physicians should bear in mind that US can be unreliable in some patients with PDR. Thus, caution is warranted in making diagnoses and determining the appropriated surgical procedure.

Exophthalmos due to Blue Rubber Bleb Syndrome

PURPOSE: Blue rubber bleb syndrome (BRBNS) is a rare disorder characterized by multiple, distinctive cavernous hemangiomas of the skin, and gastrointestinal tract. We investigated the surgical treatment and clinical findings for multiple hemangiomas in the orbit of a patient who had BRBNS on the skin and liver. METHODS: A 33-year-old white woman visited our clinic with the chief complaint of continuous exophthalmos of one year duration. She did not complain of ocular pain or decreased visual acuity. Nine years previously, her medical history showed the removal of a mass from her left arm, the result of histopathologic examination was multiple hemangiomas. Check-up for gastrointestinal lesions by colonoscopy was negative and all hematological parameters were normal. The orbital mass was surgically removed. Histopathological finding showed it to be the same as hemangioma. RESULTS: Multiple bluish nodules on the skin, visceral hemangioma, multiple hemangiomas in orbit led to the diagnosis of BRBNS. CONCLUSIONS: Multiple hemangiomas in orbit should be suspected as BRBNS, and therefore systemic evaluation is required to consider the association with BRBNS.

Clinical Evaluation of Radiation Retinopathy

PURPOSE: To assess variable clinical findings and risk factors of radiation retinopathy and to evaluate the effects of laser photocoagulation. METHODS: We reviewed the medical charts of 55 patients who received fractionated external-beam radiation during the treatment of head and neck tumors and who had a minimum of 2 years of follow-up from January 1996 to June 2002. RESULTS: Thirteen eyes in 8 patients developed radiation retinopathy. The mean time to the onset of symptoms attributable to retinal ischemia was 28 months (range, 15 to 43 months). The most common initial visual symptom was decreased visual acuity. Retinal hemorrhages, hard exudates and cotton wool spots were frequently observed fundus findings, and capillary non-perfusion on fluorescein angiography was the invariable findings. The mean total radiation dose was significantly higher in the retinopathy positive group (66.9+/-5.7 Gy) than in the retinopathy negative group (55.4+/-15.8 Gy) (P<0.05). Laser photocoagulation was performed in nine eyes of which 7 had good prognosis for retaining and regaining good central vision at the last follow-up. CONCLUSIONS: Although radiation retinopathy is infrequent, the long-term visual outcome is good with adequate laser photocoagulation treatment when detected early by close and regular follow-up.

A Case of MALToma Found in Bilateral Lacrimal Gland and Hard Palate

PURPOSE: Lymphoma originated from MALT is common in stomach but infrequently found in bronchus, salivary gland, thyroid gland and orbit. We report a case of multifocal MALToma in bilateral main lacriamal gland, hard palate without systemic metastasis. METHODS: A 45-year-old male without known systemic disease visited with movable mass in left upper eyelid for 5 months. RESULTS: We found the mass which was hot uptaked by whole body SPECT in left main lacrimal gland and hard palate. By excisional biopsy, the mass was diagnosed as MALToma. After 1 year it recurred in contralateral main lacrimal gland. It was diagnosed as the same MALToma by excisional biopsy. Relapse and other metastasis have not been observed yet up to now(November, 2002) , since we treated radiation therapy.