Secondary Intraocular lymphoma of the iris following a succussefully treated diffuse large B‐cell lymphoma of the orbit

Abstract

AbstractPurpose To report clinical findings of a rare case of lymphoma with iris involvement and therapeutic approach with local application of rituximabMethods Case reportResults A¬n 80‐year old patient reported blurred vision in the right eye for one week. After dacryodacryocystorhinostomy he suffured from decreased vision, chemosis and double vision on downgaze. MRI of the head revealed a right orbital tumor mass, arising from a distinct tumor mass of the right maxillary and ethmoid sinuses. Biopsy revealed CD5‐positive, diffuse large B‐cell lymphoma. The patient was managed with tumor debulking and systemic chemotherapy. At completion of therapy he remained in remission until presentation of a cutaneous relapse on the lower leg with simultaneous eye discomfort. On ocular examination the visual acuity was hand motion in the right eye with normal Intraocular pressure.The right eye showed diffuse keratic precipitates and moderate cells and flare in the anterior chamber.From 8 to 1 o‘clock the iris showed diffuse thickening of the stroma and irregular pupil.Examination with ultrasound biomicroscopy showed involvement of the anterior part of the cilliary body. Posterior segment examination was unremarkable. Aspiration of the anterior chamber showed CD20 positive, atypical lymphocytes, compatible with the previously diagnosed non‐Hodgkin’s lymphoma. After local application of rituximab three weeks later the thickening of the iris tissue had resolved.Conclusion Lymphomatous involvement oft he iris should be considered in the differential diagnosis of a severe anterior uveitis in elderly patients with known aggressive systemic lymphoma. An additional local application of rituximab may be suggested in isolated iris lymphoma.