Abstract
Abstract: :
Purpose: To investigate clinical features, histopathology, treatments, visual acuity outcomes, and complications associated with lymphoma. Methods: Medical record review of all patients with ocular manifestations of lymphoma at Bascom Palmer Eye Institute between 1/87 and 12/00. Results: Sixty-seven eyes of 45 patients followed a median of 2.7 years (range, 0-7.3 years) were identified. Fourteen (31%) patients had systemic lymphoma prior to presentation with ocular findings, including 5 (11%) with mycosis fungoides. Twenty-three (51%) patients had tumor presentation confined to the orbit, and 4 (9%) had tumors extending out of the orbit. Eight (18%) had tumor involving the eyelids, 9 (20%) involved the conjunctiva, 5 (11%) involved the vitreous, 4 (9%) involved the retina and choroid, and 7 (15%) involved the optic nerve. Three (7%) had severe meibomianitis and thickened eyelids, and 2 (4%) had anterior chamber reaction. Lymphoma was of B cell origin in 19 patients and of T cell origin in 1 patient. Presenting vision was ≷20/40 in 47/67 (70%), 20/50-≷20/200 in 9/67 (13%), <20/200 in 11/67 (16%) with visual acuities on final follow-up 36/59 (61%), 10/59 (17%), and 13/59 (22%), respectively. Treatment included local radiation in 32/45 (71%), systemic steroids in 14 (31%), chemotherapy in 5 (11%), and excision in 1 (2%). Intrathecal and intravenous methotrexate was used in 1 (2%) patient. Two (4%) patients underwent pars plana vitrectomy. Disease complications included exudative retinal detachment in 1 patient, epiretinal membrane in 2, and death in 3 patients. Treatment complications included keratitis sicca in 17, cataract formation in 16, neovascular glaucoma in 2, radiation retinopathy in 3, trichiasis in 1, entropion in 1, punctal eversion in 1, and esophagitis in 1. Two patients had orbital recurrence of lymphoma. Conclusion: The orbit and eyelids were the most frequently involved locations in ocular lymphoma; ocular manifestations led to the diagnosis of systemic disease in 31 (45%) patients. Visual acuities remained stable. Although treatment successfully controlled lymphoma in most patients, complications from treatment were frequent.
Keywords: 610 tumors • 501 orbit • 353 clinical (human) or epidemiologic studies: outcomes/complications