ABSTRACT
Purpose: To report a case of bilateral vitritis originated from Primary Central Nervous System Lymphoma. Diagnosis was made from a careful history taking and confirmed with vitrectomy. Case report: 65-year-old Vietnamese male had one month of progressive blurred vision in both eyes without other eye complaint. History revealed that about one year previously, he was diagnosed with primary diffuse large B cell lymphoma. He was treated with chemotherapy of Methotrexate 3.5 g/m2and cytarabine 2 mg/m2, and a whole brain radiation therapy. There was a complete remission after the therapy. Fundus of both eyes was partly obscured by cells mainly in the posterior vitreous. Sequential bilateral vitrectomies were done on 5/1/17 and 7/17/17 without complication. The vitreous sample from the first eye having vitrectomy was sent for study which demonstrated large B cell lymphoma. Post-operative vision improved to 20/25 both eye without the complaint of hazy vision. Conclusion: Good history taking assisted in the diagnosis of intraocular lymphoma in this case with bilateral vitritis. However, bilateral vitrectomy restored the vision and further confirmed the diagnosis of lymphoma for future follow up care
Objetivo: Reportar un caso de vitritis bilateral originada por un Linfoma del Sistema Nervioso Central Primario. El diagnóstico se realizó a partir de una cuidadosa historia clínica y confirmada con vitrectomía. Reporte de caso: Varón vietnamita de 65 años con un mes de visión borrosa progresiva en ambos ojos sin otra afección ocular. La historia reveló que hace aproximadamente un año, se le diagnosticó un linfoma difuso primario de células B grandes. Fue tratado con quimioterapia con Methotrexate 3.5 g/m2 y citarabina 2 mg/m2 y una radioterapia cerebral completa. Hubo una remisión completa después de la terapia. El fondo de ambos ojos estaba parcialmente oscurecido por las células, principalmente en el vítreo posterior. Las vitrectomías bilaterales secuenciales se realizaron el 5/1/17 y el 17/7/17 sin complicaciones. La muestra vítrea del primer ojo sometida a vitrectomía fue enviada a un estudio que demostró linfoma de células B grandes. La visión postoperatoria mejoró a 20/25 ambos ojos sin la queja de la visión borrosa. Conclusión: una buena historia clínica fue útil en el diagnóstico de linfoma intraocular en este caso con vitritis bilateral. Sin embargo, la vitrectomía bilateral restauró la visión y confirmó aún más el diagnóstico de linfoma para el cuidado de seguimiento futuro.
Subject(s)
Humans , Male , Aged , Vitrectomy , Vitreous Body/diagnostic imaging , Eye Diseases/diagnosis , Lymphoma, B-Cell/diagnosisABSTRACT
Intermediate Uveitis (IU) is an inflammatory disease, primarily involving the vitreous and peripheral retina. It accounts for around 8% of cases of uveitis and affects primarily children and young adults. The etiology is unknown but, found as an isolated and idiopathic condition or in association with systemic disorders such as multiple sclerosis and sarcoidosis and infectious diseases. Symptoms include painless blurring of vision, floaters and deterioration of vision. Clinical features seen are anterior segment affection with keratic precipitates and anterior chamber cells, vitritis, vasculitis in the peripheral retina, vitreal snow banks and cystoid macular edema (CME). CME was the major threat for deterioration of vision; other complications include vitreous haemorrhage, periphlebitis, cataract and glaucoma. Treatment of intermediate uveitis is based on periocular and oral corticosteroids. Cryotherapy or laser photocoagulations of the peripheral retina are options in patients when there is an insufficient response to periocular or systemic corticosteroids. Immunomodulatory therapy is used when other therapies fail. Pars plana vitrectomy (PPV) is indicated in patients with chronic significant inflammation, non-responsive cystoid macular edema, non-clearing vitreous haemorrhage, tractional retinal detachment and epiretinal membranes. IU is an intraocular inflammation involving the anterior vitreous, peripheral retina and pars plana. It usually affects patients from 5 to 30 years old, without gender or racial preferences. The etiology is unknown but there are several associated diseases. The long-term prognosis of intermediate uveitis is usually good, particularly with strict control of inflammation and with proper management of complications.
ABSTRACT
PURPOSE: We report a patient of ocular syphilis with acquired immune deficiency syndrome(AIDS) who showed dense vitritis as the primary manifestation without signs of retinitis, and who underwent pars plana vitrectomy. METHODS: A 65-year-old man known to have AIDS complaining of decreased vision in both eyes, was transferred for suspected CMV retinitis. Visual acuity was 0.2 in the right eye and 0.4 in the left eye. Ganciclovir was prescribed intravenously for 10 days and orally thereafter. After 2 months, the visual acuity of both eyes decreased to hand motion. As additional serologic tests such as TPHA and FTA-ABS were positive for syphilis, 5 MU of penicillin G was injected intravenously four times a day for 3 weeks. RESULTS: Although active inflammation decreased with the antibiotic treatment, vitreous opacity persisted. Visual acuity was counting fingers in the right eye and 0.02 in the left eye. Pars plana vitrectomy was performed on the right eye. Analysis of the aspirated vitreous disclosed a VDRL titer of 1:8, and that TPHA was positive while PCR for CMV was negative. One month after the operation, the patient's visual acuity had improved to 0.6. CONCLUSIONS: Ocular syphilis should be considered in AIDS patient showing dense vitritis as primary manifestation. Pars plana vitrectomy may be an option for early visual restoration of these patients.