Ocular manifestations of systemic lymphoma

Abstract Purpose: A comprehensive understanding of the ocular presentations of systemic lymphoma (SL) is needed for early recognition and treatment to improve outcomes. Design: A retrospective study. Methods: The ocular manifestations of 17 patients with SL were retrospectively summarized. Results: Among 17 SL patients, 12 (21 eyes) presented with secondary vitreoretinal lymphoma (SVRL) and five (8 eyes) presented with viral retinitis. Among those with SVRL, 16 eyes (76.2%) exhibited only vitreoretinal involvement, three eyes (14.3%) had both choroid and vitreoretinal involvement, and two eyes (9.5%) showed lacrimal gland and vitreoretinal involvement. Ocular symptoms occurred at a median interval of 63 months (range: 4–220 months) after SL diagnosis. Ocular manifestations included keratic precipitates in 10 eyes (47.6%), anterior chamber cells in 10 eyes (47.6%), vitreous cells in 18 eyes (85.7%), subretinal infiltrates in six eyes (28.6%), optic nerve involvement in three eyes (14.3%), neovascular glaucoma in five eyes (23.8%), and ciliary body/choroidal involvement in three eyes (14.3%). Patients received intravitreal methotrexate injections and systemic chemotherapy. The 3-year survival rate was 47.5%. Viral retinitis manifested as vitritis, peripheral retinal focal necrosis, and retinal vasculitis, and among those five patients, the median interval from SL diagnosis to ocular involvement was 15 months (range: 9–28 months). These patients received antiviral therapy and intravitreal ganciclovir injections. Conclusions: SVRL and viral retinitis are two ocular manifestations of SL. Vitreous biopsy and PCR testing are valuable for distinguishing between them. Our findings support the importance of long-term ocular surveillance in patients with SL.