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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 286 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 239 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 200 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 175 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 266 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 286 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 182 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 207 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 201 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 171 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 145 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 140 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 143 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 181 views00000
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Uveitis and Retinal Whitening - 04-27-12 - Prior to PPV OD - Possible Primary Ocular Lymphoma 181 views00000
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Primary Ocular Lymphoma - 051812 154 views00000
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Primary Ocular Lymphoma - 051812 124 views00000
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Primary Ocular Lymphoma - 051812 143 views00000
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Primary Ocular Lymphoma - 051812 155 views00000
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Primary Ocular Lymphoma - 051812 135 views00000
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Primary Ocular Lymphoma - 051812 129 views00000
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Primary Ocular Lymphoma - 051812 140 views00000
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Primary Ocular Lymphoma - 051812 130 views00000
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Primary Ocular Lymphoma - 051812 142 views00000
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Primary Ocular Lymphoma - 051812 140 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 191 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 224 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 145 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 224 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 207 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 215 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 166 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 217 views00000
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POL3_DEWI_11271235.jpg
Primary Ocular Lymphoma - White Mass Left Eye - 112712 170 views00000
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POL3_DEWI_11271236.jpg
Primary Ocular Lymphoma - White Mass Left Eye - 112712 156 views00000
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POL3_DEWI_11271237.jpg
Primary Ocular Lymphoma - White Mass Left Eye - 112712 123 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 237 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 194 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 153 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 145 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 171 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 144 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 120 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 132 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 186 views00000
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Primary Ocular Lymphoma - White Mass Left Eye - 112712 122 views00000
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POL4_DEWI_020513_heidelberg64.jpg
Primary Ocular Lymphoma - 020513 142 views00000
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Primary Ocular Lymphoma - 020513 146 views00000
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Primary Ocular Lymphoma - 020513 166 views00000
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Primary Ocular Lymphoma - 020513 125 views00000
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Primary Ocular Lymphoma - 020513 - FUndus Autofluorescence208 views00000
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Primary Ocular Lymphoma - 020513 - FUndus Autofluorescence212 views00000
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Primary Ocular Lymphoma - 020513 - FUndus Autofluorescence232 views00000
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Primary Ocular Lymphoma - 020513 - FUndus Autofluorescence130 views00000
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Primary Ocular Lymphoma - 020513 - FUndus Autofluorescence233 views00000
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Primary Ocular Lymphoma - 020513 - FUndus Autofluorescence256 views00000
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Primary Ocular Lymphoma - 020513 - FUndus Autofluorescence256 views00000
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Primary Ocular Lymphoma - 020513 - SD OCT236 views00000
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Primary Ocular Lymphoma - 020513 - SD OCT255 views00000
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Primary Ocular Lymphoma - 020513 - SD OCT275 views00000
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POL4_DEWI_020513_heidelberg78.avi
Primary Ocular Lymphoma - 020513 - SD OCT233 viewsVIDEO TAKES TIME TO LOAD00000
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POL4_DEWI_020513_heidelberg79.avi
Primary Ocular Lymphoma - 020513 - SD OCT192 viewsVIDEO TAKES TIME TO LOAD00000
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Primary Ocular Lymphoma - 020513 - SD OCT - SD OCT385 views00000
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POL4_DEWI_020513_heidelberg82.avi
Primary Ocular Lymphoma - 020513 - SD OCT216 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.