Authors: Marieta Dumitrache, Miruna Cioboata, Cioboata ML.
Intraocular lymphoma includes a group of malignant tumors, originating in the lymphohematopoietic tissue, with reserved prognosis. The risk factors are multiple: chromosomal translocation, infections (Epstein Barr), immunodeficiency, chemotherapy, radiation exposure. Intraocular lymphoma can be primary (vitreoretinal and uveal), and secondary. The uveal one is choroidal or with damage to the iris and ciliary body. Primary vitreoretinal lymphoma, more common bilaterally asymmetric, present at 50-70 years old, can be associated with primary CNS lymphoma or by CNS dissemination with malignant cells, B lymphocytes. Clinically, the anterior pole is not affected, but the posterior pole presents cloudy vitreous with vision in haze, “leopard spot” retinal changes with subretinal infiltrates and lymphomatous foci. In choroidal uveal lymphoma, the anterior pole and vitreous are not affected or show minor signs, but multiple chorioretinal infiltrates, retinal detachment, optic disc edema, sometimes macular damage are present. Lymphoma of the iris and ciliary body, often unilateral, has an iridociliary reaction of variable intensity, with an average vitreous reaction. Secondary lymphoma is metastasis from systemic lymphoma. Treatment in lymphoma depends on the tumor's stage of evolution, stage I-II or III-IV, but also on the type of lymphoma: indolent or aggressive. Treatment options are selected depending on the age, general condition, volume, extent, histology of the tumor. Rituximab can be effective alone, or combined with: cyclophosphamide, doxurubicin, vincristine, prednisone, in repeated courses. If necessary, STEM cell transplantation can be performed, autologous, repeated with allogeneic STEM cells, CAR-T cells. If necessary, local chemotherapy can be applied with intravitreal methotrexate, rituximab, associated with systemic chemotherapy. Surgical treatment might be necessary in some cases with enucleation, exenteration.
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