Abstract
In this case report, we aim to describe a rare case of recurrent diffuse large B-cell lymphoma (DLBCL) reportedly in remission presenting with primary anterior segment findings and use of intravitreal bevacizumab and methotrexate to treat the sequelae. The patient presented with hypopyon and neovascularization of the iris (NVI). Anterior chamber studies including flow cytometry and imaging revealed DLBCL recurrence with central nervous system (CNS) involvement. Over one month, he was treated with one intravitreal injection of bevacizumab, repeat injections of methotrexate, and systemic therapies with the resolution of ocular symptoms but persistent systemic disease. This case highlights the utility of anterior chamber paracentesis in diagnosis and intravitreal bevacizumab and methotrexate in the treatment for anterior segment manifestations of intraocular lymphoma (IOL).
Highlights
Intraocular lymphoma (IOL) can be primary, which typically originates from the central nervous system (CNS), or secondary from metastasis outside of the CNS
Secondary IOL (SIOL) is an important diagnosis on the differential in cases of bilateral acute and severe anterior uveitis that recurs with treatment
We describe a unique case of anterior segment findings of SIOL and the management of its sequelae
Summary
Intraocular lymphoma (IOL) can be primary, which typically originates from the central nervous system (CNS), or secondary from metastasis outside of the CNS. It is a rare condition, typically of B-cell origin, and usually associated with primary CNS non-Hodgkin’s lymphoma. Primary IOL usually presents as vitreoretinal lymphoma. Secondary IOL (SIOL) presents with a higher incidence of anterior uveitis, ocular hypertension, and bilateral disease. The prognosis for IOL is poor, with limited treatment options [1]. SIOL is an important diagnosis on the differential in cases of bilateral acute and severe anterior uveitis that recurs with treatment. The most common primary site in these cases is the skin [2]. Iris and anterior segment involvement have only been noted in a few case reports, and even fewer note the usage of antivascular endothelial growth factor (anti-VEGF) therapy
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