原发性眼内淋巴瘤13例

摘要

目的 观察原发性眼内淋巴瘤(PIOL)的临床表现.方法 回顾分析临床及病理检查确诊的13例PIOL患者24只眼的临床资料,着重分析其眼部表现.除常规眼科检查外,屈光间质清楚者同时行荧光素眼底血管造影(FFA)和光相干断层扫描(OCT)检查.所有患者行诊断性玻璃体手术,其中经玻璃体细胞病理分析确诊11例,视网膜活检确诊1例,后期发生神经系统症状神经科活检确诊1例.结果 患者中男性5例,女性8例；平均年龄(55.7±12.6)岁.单眼发病2例,双眼发病11例.中枢神经系统淋巴瘤合并PIOL者9例16只眼,占患眼的66.7％;单纯PIOL者4例8只眼,占患眼的33.3％.患者视力为光感～1.0.孤立性玻璃体炎型PIOL 14只眼,占58.3％；玻璃体视网膜型PIOL 10只眼,占41.7％.FFA检查发现,孤立性玻璃体炎型PIOL无异常表现；玻璃体视网膜型PIOL均有广泛的视网膜色素上皮(RPE)病变.OCT检查发现,孤立性玻璃体炎型PIOL无异常表现；玻璃体视网膜型PIOL的RPE和Bruch膜之间呈强反射.结论 PIOL临床表现多种多样,以双眼发病居多；玻璃体视网膜型存在广泛的RPE病变.%Objective To observe the clinical features of primary intraocular lymphoma (PIOL).Methods The clinical data of 13 patients (24 eyes) of PIOL were retrospectively analyzed.In addition to routine ophthalmic examination,auxiliary examination including fluorescein fundus angiography (FFA) and optical coherence tomography (OCT) were carried out in patients without opacity of refractive media.All the patients were underwent diagnostic vitreous surgery. Eleven patients were confirmed by cellular pathology analysis,one patient was confirmed by retinal biopsy,and one patient was confirmed by neurology biopsy.The clinical features of these patients were observed.Results There were 16 eyes of nine patients (66.7％) with primary central nervous system lymphoma and PIOL,and eight eyes of four patients (33.3％) with PIOL only.The patients included five males and eight females,with a mean age of (55.7±12.6) years.Two patients were affected unilaterally and 11 patients affected bilaterally.Their visual acuity ranged from light perception to 1.0. Fourteen eyes (58.3％) were classified as isolated vitreous inflammation type and 10 eyes (41.7％) were classified as vitreous retinal type.FFA results showed that there was no abnormalities in PIOL patients of isolated vitreous inflammation type,but there were extensive lesions of retinal pigment epithelium (RPE) observed in PIOL patients of the vitreous retinal type.OCT results showed that there were no abnormalities in PIOL of patients of isolated vitreous inflammation type,but hyperreflexia between RPE and Bruch's membrane was observed in PIOL patients of vitreous retinal type.Conclusion The clinical manifestation of PIOL are diversified,mostly in bilaterally affected cases.There are extensive lesions of RPE in patients of vitreous retinal type.