Dr. venu muralidhar

DR. ANUSHA VENKATARAMAN

Abstract

We report an unusual presentation of primary intraocular lymphoma (PIOL). A 71 year old female presented with sudden decrease of vision to light perception in the left eye of 15 days duration. The patient had a similar history in the right eye 6 months back which was now lost to neovascular glaucoma. The fundus in the left eye was suggestive of an infiltrative optic neuropathy. The cytopathology report suggested presence of numerous lymphoid cells in a necrotic background indicating the possibility of intraocular lymphoma. MRI of the brain and orbits showed bilateral optic nerve head enhancement with a lesion on the right optic nerve head. Masquerade syndrome was ruled out. The patient was initiated on intravitreal methotrexate and after 17 injections of intravireal methotrexate, vision improved from perception of light to 6/24. Such a presentation of PIOL with asymmetric bilateral infiltrative optic neuropathy in the absence of CNS lymphoma has not been reported till date.