视网膜淋巴瘤治疗中视网膜动脉阻塞1例并文献复习

doi:10.6040/j.issn.1673-3770.0.2022.444

摘要/Abstract

摘要： 目的报道1例玻璃体视网膜淋巴瘤治疗过程中出现视网膜动脉阻塞病例的临床特征及治疗要点,分析其形成的相关原因。方法回顾该病例的诊断和治疗过程,结合病例资料及相关文献进行分析讨论。结果入院后根据病史、症状及体征,行眼内液细胞因子检测及基因重排,诊断为“玻璃体视网膜淋巴瘤”。给予多次玻璃体腔注射甲氨蝶呤治疗,定期复查,拟行再次玻璃体腔注射前,出现视网膜动脉阻塞。结论玻璃体视网膜淋巴瘤的诊断具有挑战性,因其临床症状可以模仿其他眼部疾病,在治疗过程中,需要关注眼部及全身系统情况,提高患者生活质量及生存时间。

关键词: 玻璃体视网膜淋巴瘤, 甲氨蝶呤, 视网膜动脉阻塞, 治疗

Abstract: Objective This study reports the clinical features and treatment of a case of retinal artery occlusion during vitreoretinal lymphoma treatment. We also analyze and describe the relevant reasons for retinal artery occlusion formation. Methods The diagnosis and treatment of the case were reviewed. The case data and related literature were analyzed and discussed. Results After admission, according to the medical history, symptoms, and signs, cytokines in intraocular fluids and gene rearrangement were detected and a diagnosis of "vitreoretinal lymphoma" was established. Methotrexate intravitreal injection and regular follow-up were performed. However, retinal artery occlusion occurred before another planned intravitreal injection. Conclusion Vitreoretinal lymphoma diagnosis is challenging because its clinical symptoms could mimic other eye diseases. In the treatment course, attention should be paid to the eye and systemic system to improve patients' quality of life and survival time.

Key words: Retinal artery occlusion, Primary vitreoretinal lymphoma, Methotrexate, Treatment

中图分类号:

R774.1

赵慧,黄超,崔文轩,司明威,杨梦瑶,王红,周芳. 视网膜淋巴瘤治疗中视网膜动脉阻塞1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2023, 37(5): 123-127.

ZHAO Hui, HUANG Chao, CUI Wenxuan, SI Mingwei, YANG Mengyao, WANG Hong, ZHOU Fang. Retinal artery occlusion during treatment of primary vitreoretinal lymphoma:a case report and literature review[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(5): 123-127.

参考文献

[1] Chan CC, Rubenstein JL, Coupland SE, et al. Primary vitreoretinal lymphoma: a report from an international primary central nervous system lymphoma collaborative group symposium[J]. Oncologist, 2011, 16(11): 1589-1599. doi:10.1634/theoncologist.2011-0210
[2] Sagoo MS, Mehta H, Swampillai AJ, et al. Primary intraocular lymphoma[J]. Surv Ophthalmol, 2014, 59(5): 503-516. doi:10.1016/j.survophthal.2013.12.001
[3] 蒋婷婷, 李睿文, 刘师学, 等. 原发性玻璃体视网膜淋巴瘤: 10年诊治回顾[J]. 中华眼底病杂志, 2022(5): 376-381. doi:10.3760/cma.j.cn511434-20220310-00126 Jiang TT, Li RW, Liu SX, et al. The diagnosis and treatment of primary vitreoretinal lymphoma: 10 years of experience[J]. Chinese Journal of Ocular Fundus Diseases, 2022(5): 376-381.doi:10.3760/cma.j.cn511434-20220310-00126
[4] Pulido JS, Johnston PB, Nowakowski GS, et al. Correction to: the diagnosis and treatment of primary vitreoretinal lymphoma: a review[J]. Int J Retina Vitreous, 2018, 4: 22. doi:10.1186/s40942-018-0126-y
[5] Chan CC, Sen HN. Current concepts in diagnosing and managing primary vitreoretinal(intraocular)lymphoma[J]. Discov Med, 2013, 15(81): 93-100.
[6] Pulido JS, Johnston PB, Nowakowski GS, et al. The diagnosis and treatment of primary vitreoretinal lymphoma: a review[J]. Int J Retina Vitreous, 2018, 4: 18. doi:10.1186/s40942-018-0120-4
[7] Whitcup SM, Stark-Vancs V, Wittes RE, et al. Association of interleukin 10 in the vitreous and cerebrospinal fluid and primary central nervous system lymphoma[J]. Arch Ophthalmol, 1997, 115(9): 1157-1160. doi:10.1001/archopht.1997.01100160327010
[8] Finger PT, Papp C, Latkany P, et al. Anterior chamber paracentesis cytology(cytospin technique)for the diagnosis of intraocular lymphoma[J]. Br J Ophthalmol, 2006, 90(6): 690-692. doi:10.1136/bjo.2005.087346
[9] Frenkel S, Pe'er J, Kaufman R, et al. The importance of cytokines analysis in the diagnosis of vitreoretinal lymphoma[J]. Acta Ophthalmol, 2020, 98(6): e668-e673. doi:10.1111/aos.14347
[10] Coupland SE, Hummel M, Müller HH, et al. Molecular analysis of immunoglobulin genes in primary intraocular lymphoma[J]. Invest Ophthalmol Vis Sci, 2005, 46(10): 3507-3514. doi:10.1167/iovs.05-0401
[11] Tanaka R, Kaburaki T, Taoka K, et al. More accurate diagnosis of vitreoretinal lymphoma using a combination of diagnostic test results: a prospective observational study[J]. Ocular Immunol Inflamm, 2022, 30(6): 1354-1360. doi:10.1080/09273948.2021.1873394
[12] Sehgal A, Pulido JS, Mashayekhi A, et al. Diagnosing vitreoretinal lymphomas-an analysis of the sensitivity of existing tools[J]. Cancers, 2022, 14(3): 598. doi:10.3390/cancers14030598
[13] 陈秀菊, 常青, 江睿, 等. 玻璃体腔注射甲氨蝶呤治疗玻璃体视网膜淋巴瘤14例[J]. 中华眼底病杂志, 2016, 32(4): 399-403. doi:10.3760/cma.j.issn.1005-1015.2016.04.013 CHEN Xiuju, CHANG Qing, JIANG Rui, et al. Intravitreal methotrexate chemotherapy in the treatment of 14 patients with priamary vitreoretinal lymphoma[J]. Chinese Journal of Ocular Fundus Diseases, 2016, 32(4): 399-403. doi:10.3760/cma.j.issn.1005-1015.2016.04.013
[14] 朱婕, 李喆, 徐敏, 等. 原发于中枢神经系统淋巴瘤的眼内淋巴瘤1例[J]. 中华眼底病杂志, 2022, 38(7): 601-603. doi:10.3760/cma.j.cn511434-20210824-00458 ZHU Jie, LI Zhe, XU Min, et al. Intraocular lymphoma with primary central nervous system lymphoma: a case report[J]. Chinese Journal of Ocular Fundus Diseases, 2022, 38(7): 601-603. doi:10.3760/cma.j.cn511434-20210824-00458
[15] Frenkel S, Hendler K, Siegal T, et al. Intravitreal methotrexate for treating vitreoretinal lymphoma: 10 years of experience[J]. Br J Ophthalmol, 2008, 92(3): 383-388. doi:10.1136/bjo.2007.127928
[16] Castellino A, Pulido JS, Johnston PB, et al. Role of systemic high-dose methotrexate and combined approaches in the management of vitreoretinal lymphoma: a single center experience 1990-2018[J]. Am J Hematol, 2019, 94(3): 291-298. doi:10.1002/ajh.25350
[17] Bannwarth B, Péhourcq F, Schaeverbeke T, et al. Clinical pharmacokinetics of low-dose pulse methotrexate in rheumatoid arthritis[J]. Clin Pharmacokinet, 1996, 30(3): 194-210. doi:10.2165/00003088-199630030-00002
[18] Rizkalla K, Rodrigues S, Proulx A, et al. Primary intraocular lymphoma arising during methotrexate treatment of temporal arteritis[J]. Can J Ophthalmol, 2005,40(5):585-592. doi: 10.1016/S0008-4182(05)80050-X
[19] Gill MK, Jampol LM. Variations in the presentation of primary intraocular lymphoma: case reports and a review[J]. Surv Ophthalmol, 2001, 45(6): 463-471. doi:10.1016/s0039-6257(01)00217-x
[20] Gass JD, Trattler HL. Retinal artery obstruction and atheromas associated with non-Hodgkin's large cell lymphoma(reticulum cell sarcoma)[J]. Arch Ophthalmol, 1991, 109(8): 1134-1139. doi:10.1001/archopht.1991.01080080094039
[21] Gezer S, Vural B, Kirsavoglu M, et al. Branch retinal artery occlusion in a patient undergoing Methotrexate therapy for ectopic pregnancy: a case report[J]. J Pak Med Assoc, 2020, 70(2): 357-359. doi:10.5455/JPMA.14284
[22] Fierz AB, Sartoretti S, Thoelen AM. Optic neuropathy and central retinal artery occlusion in non-Hodgkin lymphoma[J]. J Neuroophthalmol, 2001, 21(2): 103-105. doi:10.1097/00041327-200106000-00009
[23] 赵兴贺, 樊明月, 窦训武, 等. 儿童原发扁桃体弥漫大B细胞淋巴瘤1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 120-124. doi:10.6040/j.issn.1673-3770.0.2021.366 ZHAO Xinghe, FAN Mingyue, DOU Xunwu, et al. Primary large B-cell lymphoma of tonsil in children: a case report and document review[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 120-124. doi:10.6040/j.issn.1673-3770.0.2021.366
[24] Carbonell D, Mahajan S, Chee SP, et al. Consensus recommendations for the diagnosis of vitreoretinal lymphoma[J]. Ocul Immunol Inflamm, 2021, 29(3): 507-520. doi:10.1080/09273948.2021.1878233
[25] Habot-Wilner Z, Frenkel S, Pe'er J. Efficacy and safety of intravitreal methotrexate for vitreo-retinal lymphoma- 20 years of experience[J]. Br J Haematol, 2021, 194(1): 92-100. doi:10.1111/bjh.17451

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