Bilateral primary vitreoretinal lymphoma- case report

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Nur Aliah Hassan
Dr. Rajasudha
Dr. Azian
Professor Zunaina
Dr. Hanizasurana



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. The right eye (RE) was worse than the left eye (LE). RE visual acuity (VA) was counting finger 1 foot and LE VA was 6/36 pinhole (PH) 6/24. 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 infiltrateseen. Systemic examination was uneventful. 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 bilateral primary vitreoretinal lymphomaand intravitreal injection of Methotrexate was initiated.  MRI brain surveillance was planned for every 6 months. Her RE vision improved to 6/18 PH 6/12 and 6/12 PH 6/9 in the LE after completed 14 courses of intravitreal Methotrexate.

Conclusion: Primary vitreoretinal lymphomais a rare disease in older patientsthat mimics a steroid-resistant chronic uveitis with associated vitritis.Primary vitreoretinal lymphomaremains a diagnostic and therapeutic challenge and its suspicion should always remain despite normal investigation results if presentation is atypical.

Conflicts of Interest: The author reports no conflicts of interest.

Keywords:Primary vitreoretinal lymphoma, vitreous biopsy, vitritis



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Case Report


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