Abstract
Purpose: :
To describe the clinical features of posterior uveal lymphoid neoplasia (PULN).
Methods: :
Noncomparative series of 25 eyes of 21 patients managed at the Oncology Service, Wills Eye Institute.
Results: :
The mean age of patients was 61 years (range, 44-80), 90% were Caucasian, and 81% were male. The most common symptoms were blurred vision (56%), red eye (12%), floaters (8%), and 24% were asymptomatic. The mean duration of symptoms before referral was 13 months (range, 1-60 months). 43% of patients were referred with the correct diagnosis of lymphoid infiltration. 4 (19%) of patients had bilateral ocular/periocular lymphoid infiltration. Conjunctival and iris lymphoid infiltration were present in 44% and 12% of eyes, respectively, and iritis/keratic precipitates were seen in 6 eyes (24%). All eyes had involvement of the macula whereas involvement of the foveola by the lymphoid infiltration was present in 64%. Appearance of choroidal infiltration on funduscopy was patchy in 14%, diffuse in 48%, and mixed in 38% of eyes. Other funduscopic findings included optic disc swelling (32%), retinal pigment epithelial clumps (28%), and choroidal folds (16%). 92% of eyes had detectable thickening of choroid on B-scan ultrasonography and the involved choroid was acoustically hollow in 95% of these eyes. Mean choroidal thickness was 2.5 mm (range, 1.0-4.2 mm). Posterior epibulbar extension was noted in 56% of eyes on B-scan ultrasonography. Optical coherence tomography was done in 16 eyes and showed subretinal fluid in 5 eyes (31%), retinal edema in 5 eyes (31%), and irregular RPE-choriocapillaris contour in 12 eyes (75%). Tissue biopsy diagnostic of lymphoid infiltration was obtained in 87% of patients. Four (19%) patients had systemic lymphoma.
Keywords: tumors • uvea • choroid