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Kazunobu Asao, Noriyasu Hashida, Kei Nakai, Kohji Nishida; Clinical features of PIOL with optic nerve head involvement. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3140.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the clinical features of cases of primary intraocular lymphoma (PIOL) with optic nerve head involvement
We retrospectively studied 5 patients (two women, three men, the mean age 61.8±11.1 years) with optic nerve head invasion of 42 patients with a diagnosis of PIOL at our hospital between January 2010 and October 2014. After the onset of optic nerve head involvement, we examined the clinical features, invasion, changes of visual acuity, effects of local and systemic treatment and prognosis.
The period from the time of onset to the optic nerve invasion was 16±14.5 months (4-40months). Histological examination of biopsy sample revealed that the types of lymphoma were diffuse large B-cell type; 4 cases, follicular lymphoma; 1case. Visual acuity (VA) measurement revealed the following results. At the time of invasion, VA in the patients was 2/20 or less in three cases and the rest of two cases was 10/20 or more. VA was maintained during the follow-up period. Clinical features of optic disc involvement were optic disc swelling, edema, serous retinal detachment and retinal artery occlusion. Concerning the treatment, systemic chemotherapies were performed in all cases and whole brain irradiation was performed in two cases. For the local treatment, intravitreal methotrexate (IVM) was performed. Finally the times of IVM were 4.6 times (1-7 times). During the follow-up, contrast enhanced MRI was performed every three months to detect central nervous system involvement. Brain involvement was detected in one case before the invasion and finally increased to 3 cases during the follow-up period. Four cases had good prognosis with survival and one case had died.
Malignant lymphoma showed different clinical findings. Optic nerve head invasion could be a form of relapse. During the follow-up, VA did not get worse and there is a possibility that we can maintain the VA with IVM in some cases. Since optic nerve head involvement is likely to cause brain involvement, systemic medical treatment and careful observation are needed.
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