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Intravitreal injection of anti‐VEGF and diagnosis of primary intraocular‐central nervous system lymphoma
Author(s) -
GAMBRELLE J,
MISSOTTEN GS,
DELHOUM S,
DESJARDINS L,
COCHENER B
Publication year - 2010
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2010.4367.x
Subject(s) - intraocular lymphoma , medicine , primary central nervous system lymphoma , lymphoma , uveitis , ranibizumab , differential diagnosis , ophthalmology , stereotactic biopsy , pathology , surgery , chemotherapy , bevacizumab , biopsy
Purpose We report the case of the diagnosis of primary intraocular‐ central nervous system (CNS) lymphoma in a patient treated by anti‐VEGF. Methods An 88‐year old female, with a medical history of bilateral ARMD treated by intravitreal injections of ranibizumab for 1 year, was referred to our department for bilateral vitritis diagnosed 10 days after the last anti‐VEGF injection. A complete vitritis work‐up including aqueous humour analysis, magnetic resonance imaging of the brain and vitreous biopsy enabled us to confirm the diagnosis of primary intraocular‐CNS lymphoma. Results To the best of our knowledge, this is the first report of the diagnosis of primary intraocular‐CNS lymphoma in a patient treated by anti‐VEGF for ARMD. In our opinion, the occurrence of lymphoma in this case was coincidental and not due to the anti‐VEGF injections. The differential diagnosis of vitritis in elderly patients is relatively large. Endophthalmitis or uveitis has been described after anti‐VEGF injections. In such a situation, there is actually a risk of overlooking a diagnosis of intraocular lymphoma in the mistaken belief that the observed vitritis may be a reaction to administred anti‐VEGFs. If no direct time‐relationship with the anti‐VEGF injections can be found, a classic vitritis work‐up should be performed. Anti‐VEGF treatment did not impede cytological diagnosis in our patient. Conclusion Although in some none‐CNS non‐Hodgkin lymphomas (NHL) systemic anti‐VEGF therapy is added to chemotherapy schedules, the use of anti‐VEGF did not halt the spread of the lesion within the eye in this case. It can, therefore, be presumed that local anti‐VEGF therapy has no adjuvant effect in primary intraocular lymphoma.