98th Annual Meeting DOG 2000

K 411

Intraocular Non-Hodgkin-Lymphomas

M. Zierhut, G. Duncker*, J. M. Rohrbach

Background: The diagnosis and therapy of intraocular non-Hodgkin-Lymphoma (NHL) is difficult. CNS involvement has been seen at least in 25 %, and this disease has a high mortality.

Patients: From 1997 to 1999 six patients with intraocular NHL and CNS involve-ment have been observed at the University Eye Clinic in Tübingen and Halle.

Results: The age of the patients was 46 to 70 years, relation of gender was 3 : 3. In all patients, ocular involvement preceeded CNS symptoms (latency up to 17 months). In three patients, the primary ocular involvement was diagnosed as inter-mediate uveitis, in two patients as panuveitis, and in one patient as choroidal metastasis. Systemic corticosteroids led to moderate reduction of inflammation in two of these misdiagnosed cases of uveitis, but finally induced late definite diagnosis. Diagnostic vitrectomy (n = 4) has shown atypical cells in one patient but an Interleukin (IL) 10 to Interleukin 6 relation > 1 was demonstrated in two additional patients. The definite diagnosis was possible in one patient by histology of the enucleated eye, in two additional patients after stereotactic biopsy from brain tissue. All patients had developed a highly malignant NHL of B-cells. For the first period, the best therapeutical results were achieved by the combination of radiation and cytostatic therapy, but two patients died in the following treatment period.

Discussion: Whenever an intraocular inflammation does not respond promptly to corticosteroids, intraocular NHL should be kept in mind. While the finding of atypical cells after vitrectomy seems to be dependend on the additional therapy (corticosteroids), the determination of IL-10 to IL-6 ratio > 1 has been the only sign for NHL in two patients. Regarding therapy, MTX i.v. application (2 g) has been suggested for CNS lymphomas. This regiment has shown no complete remission in our patients, so that the optimal ocular therapy is still questionable.

University Eye Hospital, Schleichstr. 12, D-72076 Tübingen
*University Eye Hospital, Magdeburger Str. 8, D-06097 Halle/Saale



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