Eye South East Asia Vol.16 Issue 2 202127Bilateral Primary Vitreoretinal Lymphoma

Abstract

Title: Bilateral primary vitreoretinal lymphoma. Objective: To report a rare case of bilateral primary vitreoretinal lymphoma (PVRL). Method: Retrospective review of the patient's clinical assessment, vitreous biopsy, and response to treatment. A 64-year-old female presented with gradual painless blurring of vision, associated with floaters in both eyes for 5 months duration. Her best corrected visual acuity (BCVA) was counting finger 1 foot in the RE and 6/24 in the LE. Anterior segment examination was unremarkable. RE fundus showed severe vitritis with large vitreous clumps and hazy fundus view. Whereas LE fundus showed mild vitritis with minimal vitreous clumps inferiorly with no retinitis, vasculitis, retinal haemorrhage, or sub-retinal infiltrate. All blood investigations including infective screening and tumour markers were unremarkable. A vitreous biopsy was performed in the RE and vitreous cytology showed atypical lymphoid cells highly suspicious for malignancy. As the vitreous sample was scanty, a cell block reading could not be carried out for immunohistochemistry. Magnetic resonance imaging (MRI) of brain and orbits were normal. Patient was diagnosed with presumed bilateral PVRL and intravitreal injection of methotrexate was initiated. MRI brain surveillance was planned for every 6 months. Her BCVA improved to 6/12 in the RE and 6/9 in the LE after completed 15 courses of intravitreal methotrexate. Conclusion: PVRL is a rare disease in older patients with features of severe vitritis and absence of macular oedema that mimics chronic uveitis and poses diagnostic challenge. Intravitreal methotrexate is an effective and minimal-invasive treatment with good visual outcome if early recognition and prompt treatment. Conflicts of Interest:The author reports no conflicts of interest.