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80 Year Old Female Patient came in 1 year ago with a retinal whitening in her eye and uveitis. Her uveitis work-up was negative, and because of the retinal whitening and the uveitis, I was concerned about a possible occult acute retinal necrosis case. I put her on Valtrex, but the eyes did not get any better and the retinal whitening continued. Then later, I became concerned about a possible primary ocular lymphoma. She had an extensive cancer evaluation that was all negative. She has had MRI scans and ultimately I did a vitrectomy on both eyes. I did the right eye on May 30th of 2012 and flow cytometry and cytology was negative. That eye cleared nicely, but then, because of increasing uveitis in the left eye, I did a vitrectomy in the left eye on December 19th of 2012. That sample I sent to the lab in Miami and that result was similarly negative. I am going to send you all of the results so you have them when you see her. At this point, it has been unclear whether she had uveitis, infectious retinitis, or possibly primary ocular lymphoma. When I saw her in my office on November 27th of 2012, she had a white subretinal mass growing in the right eye and the left eye had vitreous cells. After the vitrectomy in the left eye, I started rechecking both eyes and the white subretinal mass in the right eye had doubled in size. The right eye now looks very much like it has primary ocular lymphoma. I appreciate you seeing her and, if possible, performing some sort of a biopsy of that mass, which has now grown to the point where I think a fine-needle aspiration biopsy would be possible to help secure the diagnosis. ++++++++++++ Visit 2/5/2013. 80-year-old woman has possible ocular lymphoma. She has had two vitreous biopsies, one in one eye and one in the other eye, and the tests have been negative. Recently she is manifesting increasing anemia. She also has glaucoma. She is taking Pred Forte in both eyes and Combigan in both eyes. VISUAL ACUITY: Vision OD is 20/40, OS is 20/160. IOP: OD 22, OS 24. The eyes are quiet with a posterior chamber intraocular lens in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.4. The white mass in the macula is much bigger than it was when I saw her in November. It is growing on the superior half of the macula, as well as just nasal to the optic nerve. It has about doubled in size. There are no significant vitreous cells. OS: Vertical C/D ratio is 0.4. There are patchy retinal hemorrhages. FUNDUS PHOTOGRAPHY – COLOR AND AUTOFLUORESCENCE: Color and autofluorescence photographs do show the mass to be much bigger. SPECTRALIS SD-OCT SCAN: The OCT scans over that area show the probable tumor to be about 1.5 mm high. IMPRESSION: 1. PROBABLE OCULAR LYMPHOMA – BOTH EYES DISCUSSION: I explained to the patient, given the growth of the lesion and the absence of inflammation around it, I think at this point it is likely ocular lymphoma. ++++++++++ VISIT - 1/4/2013. 80-year-old woman had a vitreous biopsy in the left eye with a fairly full vitrectomy back on December 19th, of 2012. Her vitreous was sent down to Miami where it was carefully analyzed in the pathology lab. The flow cytometry was normal. Her B cell testing was normal. The T cell testing did show two small peaks. I contacted the pathologist about that result and it is not uncommon in cerebrospinal fluid and vitreous samples, because there are so few cells, to see some peaks on the T cells. Generally that is not considered indicative of a T cell lymphoma. There is no such thing as a primary intraocular T cell lymphoma. The primary intraocular lymphomas are B cells and the findings overall were consistent with intraocular inflammation. She did have extensive blood testing by Dr. Friedberg when this all started a few years ago and that was all negative. I have not repeated the blood tests though. The vision in the left eye is better since the vitrectomy. VISUAL ACUITY: Vision OD is 20/25; OS is 20/100, PH is 20/40. IOP: OS 18. The left eye is quiet in the anterior chamber. The posterior chamber intraocular lens is in good position. EXTENDED OPHTHALMOSCOPY: OS: Vertical C/D ratio is 0.2. There is peripheral retinal hemorrhaging, less than on last visit. The retina is everywhere attached. IMPRESSION: 1. NEGATIVE VITREOUS BIOPSY FOR INTRAOCULAR LYMPHOMA 2. PANUVEITIS – BOTH EYES DISCUSSION: I explained to the patient, given all testing, it looks at the moment like she has an inflammatory panuveitis, and I am going to rerun the initial blood tests to see if anything comes up positive. Inflammatory and infectious diseases sometimes infect the posterior pole.

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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 377 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 322 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 280 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 268 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 372 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 369 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 253 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 279 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 283 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 248 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 218 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 208 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 221 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 261 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 270 views00000
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Primary Ocular Lymphoma - 051812 228 views00000
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Primary Ocular Lymphoma - 051812 222 views00000
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Primary Ocular Lymphoma - 051812 219 views00000
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Primary Ocular Lymphoma - 051812 231 views00000
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Primary Ocular Lymphoma - 051812 212 views00000
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Primary Ocular Lymphoma - 051812 202 views00000
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Primary Ocular Lymphoma - 051812 219 views00000
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Primary Ocular Lymphoma - 051812 207 views00000
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Primary Ocular Lymphoma - 051812 222 views00000
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Primary Ocular Lymphoma - 051812 212 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 280 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 336 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 225 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 302 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 290 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 296 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 350 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 292 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 306 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 247 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 232 views00000
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POL3_DEWI_11271237.jpg
Primary Ocular Lymphoma - White Mass Left Eye - 112712 198 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 315 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 281 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 243 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 277 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 275 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 263 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 225 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 203 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 266 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 199 views00000
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POL4_DEWI_020513_heidelberg64.jpg
Primary Ocular Lymphoma - 020513 223 views00000
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Primary Ocular Lymphoma - 020513 235 views00000
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Primary Ocular Lymphoma - 020513 239 views00000
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Primary Ocular Lymphoma - 020513 206 views00000
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Primary Ocular Lymphoma - 020513 - FUndus Autofluorescence285 views00000
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Primary Ocular Lymphoma - 020513 - FUndus Autofluorescence289 views00000
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Primary Ocular Lymphoma - 020513 - FUndus Autofluorescence313 views00000
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Primary Ocular Lymphoma - 020513 - FUndus Autofluorescence206 views00000
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Primary Ocular Lymphoma - 020513 - FUndus Autofluorescence329 views00000
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Primary Ocular Lymphoma - 020513 - FUndus Autofluorescence350 views00000
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Primary Ocular Lymphoma - 020513 - FUndus Autofluorescence361 views00000
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Primary Ocular Lymphoma - 020513 - SD OCT310 views00000
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Primary Ocular Lymphoma - 020513 - SD OCT327 views00000
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Primary Ocular Lymphoma - 020513 - SD OCT418 views00000
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POL4_DEWI_020513_heidelberg78.avi
Primary Ocular Lymphoma - 020513 - SD OCT315 viewsVIDEO TAKES TIME TO LOAD00000
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POL4_DEWI_020513_heidelberg79.avi
Primary Ocular Lymphoma - 020513 - SD OCT275 viewsVIDEO TAKES TIME TO LOAD00000
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67 files on 1 page(s)

80 Year Old Female Patient came in 1 year ago with a retinal whitening in her eye and uveitis. Her uveitis work-up was negative, and because of the retinal whitening and the uveitis, I was concerned about a possible occult acute retinal necrosis case. I put her on Valtrex, but the eyes did not get any better and the retinal whitening continued. Then later, I became concerned about a possible primary ocular lymphoma. She had an extensive cancer evaluation that was all negative. She has had MRI scans and ultimately I did a vitrectomy on both eyes. I did the right eye on May 30th of 2012 and flow cytometry and cytology was negative. That eye cleared nicely, but then, because of increasing uveitis in the left eye, I did a vitrectomy in the left eye on December 19th of 2012. That sample I sent to the lab in Miami and that result was similarly negative. I am going to send you all of the results so you have them when you see her. At this point, it has been unclear whether she had uveitis, infectious retinitis, or possibly primary ocular lymphoma. When I saw her in my office on November 27th of 2012, she had a white subretinal mass growing in the right eye and the left eye had vitreous cells. After the vitrectomy in the left eye, I started rechecking both eyes and the white subretinal mass in the right eye had doubled in size. The right eye now looks very much like it has primary ocular lymphoma. I appreciate you seeing her and, if possible, performing some sort of a biopsy of that mass, which has now grown to the point where I think a fine-needle aspiration biopsy would be possible to help secure the diagnosis. ++++++++++++ Visit 2/5/2013. 80-year-old woman has possible ocular lymphoma. She has had two vitreous biopsies, one in one eye and one in the other eye, and the tests have been negative. Recently she is manifesting increasing anemia. She also has glaucoma. She is taking Pred Forte in both eyes and Combigan in both eyes. VISUAL ACUITY: Vision OD is 20/40, OS is 20/160. IOP: OD 22, OS 24. The eyes are quiet with a posterior chamber intraocular lens in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.4. The white mass in the macula is much bigger than it was when I saw her in November. It is growing on the superior half of the macula, as well as just nasal to the optic nerve. It has about doubled in size. There are no significant vitreous cells. OS: Vertical C/D ratio is 0.4. There are patchy retinal hemorrhages. FUNDUS PHOTOGRAPHY – COLOR AND AUTOFLUORESCENCE: Color and autofluorescence photographs do show the mass to be much bigger. SPECTRALIS SD-OCT SCAN: The OCT scans over that area show the probable tumor to be about 1.5 mm high. IMPRESSION: 1. PROBABLE OCULAR LYMPHOMA – BOTH EYES DISCUSSION: I explained to the patient, given the growth of the lesion and the absence of inflammation around it, I think at this point it is likely ocular lymphoma. ++++++++++ VISIT - 1/4/2013. 80-year-old woman had a vitreous biopsy in the left eye with a fairly full vitrectomy back on December 19th, of 2012. Her vitreous was sent down to Miami where it was carefully analyzed in the pathology lab. The flow cytometry was normal. Her B cell testing was normal. The T cell testing did show two small peaks. I contacted the pathologist about that result and it is not uncommon in cerebrospinal fluid and vitreous samples, because there are so few cells, to see some peaks on the T cells. Generally that is not considered indicative of a T cell lymphoma. There is no such thing as a primary intraocular T cell lymphoma. The primary intraocular lymphomas are B cells and the findings overall were consistent with intraocular inflammation. She did have extensive blood testing by Dr. Friedberg when this all started a few years ago and that was all negative. I have not repeated the blood tests though. The vision in the left eye is better since the vitrectomy. VISUAL ACUITY: Vision OD is 20/25; OS is 20/100, PH is 20/40. IOP: OS 18. The left eye is quiet in the anterior chamber. The posterior chamber intraocular lens is in good position. EXTENDED OPHTHALMOSCOPY: OS: Vertical C/D ratio is 0.2. There is peripheral retinal hemorrhaging, less than on last visit. The retina is everywhere attached. IMPRESSION: 1. NEGATIVE VITREOUS BIOPSY FOR INTRAOCULAR LYMPHOMA 2. PANUVEITIS – BOTH EYES DISCUSSION: I explained to the patient, given all testing, it looks at the moment like she has an inflammatory panuveitis, and I am going to rerun the initial blood tests to see if anything comes up positive. Inflammatory and infectious diseases sometimes infect the posterior pole.