Bilateral Panocular Involvement With Mantle-Cell Lymphoma

Abstract

A 51-year-old white woman presented with complaints of bilateral red eye of 2 weeks duration associated with photophobia and blurred vision. Seventeen months prior, she had begun a series of chemotherapy regimens for mantle-cell lymphoma (MCL), confirmed by fluorescent in situ hybridization and flow cytometry, that culminated in autologous stem-cell transplantation. On presentation to our clinic, she was receiving rituximab in combination with intrathecal cytarabine for leptomeningeal involvement. Visual acuity was 20/40intherighteyeandcountfingersat1footinthelefteye.External examination revealed multiple cutaneous eyelid nodules bilaterally and a salmon patch of the bulbar conjunctiva of the right eye (Fig 1). Slit-lampexaminationwassignificantforpseudohypopyon(lymphocytesintheanteriorchamber),irregularstromalthickeningoftheiris, and infiltration of the vitreous with lymphocytes (left eye more than right) bilaterally (Figs 1 and 2), indicative of anterior and posterior chamberinvolvementofbotheyeswithlymphoma.Shewasplacedon hourly prednisone eye drops. In addition, external-beam radiation treatment (EBRT) at a dose of 14 Gy (2 Gy in seven fractions) was administered as a cone down to the area of gross ocular disease, with an additional dose of 16 Gy (2 Gy in eight fractions) to the brain. One week after initiation of EBRT, ocular signs had resolved dramatically andvisualacuitywas20/40intherighteyeand20/50inthelefteye.In