Abstract

SO.07.08

Intravitreal methotrexate treatment in a case of ocular Non-Hodgkin-Lymphoma

Eva Glaser, Christian Mayer, Claudia Zorn, Ines Lanzl, Chris Patrick Lohmann, Mathias Maier
Augenklinik, Klinikum rechts der Isar, Technische Universität München, München

Objective
The oculocerebral Non-Hodgkin-Lymphoma (NHL) which belongs to the primary central nerve system (CNS )-Non-Hodgkin-Lymphoma (CNS-NHL) affects the brain, the meninges, the spinal cord and the eye. In more than 50% of the cases of oculocerebral NHL the eye is affected before manifestation of the CNS becomes evident. Therefore the valutation and diagnosis of an ophthalmologist is of special interest.
Methods
This casereport of a 71-year-old patient with oculocerebral NHL demonstrates the clinical course from diagnosis to therapy for the period of 20 months. We describe particularly the combined intravitreal and systemic chemotherapeutic treatment of the patient.
Results
A 71-year-old patient presented with progressive painless visual loss on both eyes. He showed normal findings of the anterior segment and the retina and distinct cellular vitreous opacities. The diagnostic vitrectomy showed an unspecific inflammatory reaction. We treated the patient with clinical suspicion of uveitis with antiphlogistic drugs as the first-line-screening and the diagnostic imaging showed regular results. As the condition persisted we prompted a second diagnostic vitrectomy with cytological examination, PCR and FACS-analysis as well as MRI of the brain which led us to the diagnosis of a cerebral NHL with ocular involvement. A combined intravitreal and systemic chemotherapy with methotrexate and triamcinolone with subsequent radiotherapy followed.
Conclusions
This case illustrates that, particularly in therapy-resistant uveitis, we should think of the so called masquerade-syndrome in a NHL. Ocular manifestations can be the first signs of a NHL of the central nerve system or a systemic NHL and can precede the central nervous symptoms. An early diagnose is of special importance for the treatment and the prognosis.

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