Short communication
Vitreoretinal lymphoma: a diagnostic challenge
Linfoma vitreoretiniano: un reto diagnóstico
Read
Not available
Timeswas read the article
Total PDF
Total HTML
Share statistics
array:23 [ "pii" => "S2173579423001561" "issn" => "21735794" "doi" => "10.1016/j.oftale.2023.10.002" "estado" => "S300" "fechaPublicacion" => "2023-12-01" "aid" => "2155" "copyright" => "Sociedad Española de Oftalmología" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2023;98:718-22" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S2173579423001688" "issn" => "21735794" "doi" => "10.1016/j.oftale.2023.10.006" "estado" => "S300" "fechaPublicacion" => "2023-12-01" "aid" => "2163" "copyright" => "Sociedad Española de Oftalmología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2023;98:723-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Reporting serious incidents in medical devices used in intraocular surgery: Proposing ideas" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "723" "paginaFinal" => "726" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reporte de incidentes serios en productos sanitarios usados en cirugía intraocular. Proponiendo ideas" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Donate, L. Arias-Barquet, D. Ruiz-Casas, E. Larra-Mateos, J.C. Pastor" "autores" => array:5 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Donate" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Arias-Barquet" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Ruiz-Casas" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Larra-Mateos" ] 4 => array:2 [ "nombre" => "J.C." "apellidos" => "Pastor" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579423001688?idApp=UINPBA00004N" "url" => "/21735794/0000009800000012/v1_202312011130/S2173579423001688/v1_202312011130/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173579423001834" "issn" => "21735794" "doi" => "10.1016/j.oftale.2023.10.009" "estado" => "S300" "fechaPublicacion" => "2023-12-01" "aid" => "2174" "copyright" => "Sociedad Española de Oftalmología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2023;98:713-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Brolucizumab after failure of aflibercept with photodynamic therapy in polypoidal choroidal vasculopathy: A case report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "713" "paginaFinal" => "717" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Brolucizumab tras fracaso de aflibercept con terapia fotodinámica en vasculopatía coroidea polipoidea: reporte de un caso" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3335 "Ancho" => 2500 "Tamanyo" => 954722 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Best-corrected visual acuity: 20/32. Pictures A–D taken with Optos (Optos® California, Optos plc., Dunfermline, UK). A — Colored retinography: orange nodules in the parafoveal area (Arrowhead). B: autofluorescence: loss of physiologic foveal hypofluorescence. C — indocyanine green angiography (early phase): branching hyperfluorescent vascular network with saccular dilation at the edge (white arrow). D — fluorescein angiography: late leakage in the inferior macula (Square) and pooling superiorly. E — Spectral Domain Optic Coherence Tomography OCT (Spectralis® HRA, Heidelberg Engineering, Heidelberg, Germany): thumb-like pigmented epithelium detachment (Asterisk), subretinal fluid, thick choroid, and dilated Haller’s layer vessels.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P.H. Yuan, H.M. Khan, F.A.G. Sumita, M.L. Ribeiro Monteiro, R.C. Preti, E.V. Navajas" "autores" => array:6 [ 0 => array:2 [ "nombre" => "P.H." "apellidos" => "Yuan" ] 1 => array:2 [ "nombre" => "H.M." "apellidos" => "Khan" ] 2 => array:2 [ "nombre" => "F.A.G." "apellidos" => "Sumita" ] 3 => array:2 [ "nombre" => "M.L." "apellidos" => "Ribeiro Monteiro" ] 4 => array:2 [ "nombre" => "R.C." "apellidos" => "Preti" ] 5 => array:2 [ "nombre" => "E.V." "apellidos" => "Navajas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669123001946" "doi" => "10.1016/j.oftal.2023.10.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669123001946?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579423001834?idApp=UINPBA00004N" "url" => "/21735794/0000009800000012/v1_202312011130/S2173579423001834/v1_202312011130/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Vitreoretinal lymphoma: a diagnostic challenge" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "718" "paginaFinal" => "722" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "E. Sáenz Decker, M. García Fernández, R. Gómez De la Torre, R. Coto Hernández, L.I. Santana García" "autores" => array:5 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Sáenz Decker" "email" => array:1 [ 0 => "elensdeck@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "García Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Gómez De la Torre" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "R." "apellidos" => "Coto Hernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "L.I." "apellidos" => "Santana García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Oftalmologia, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Linfoma vitreoretiniano: un reto diagnóstico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2590 "Ancho" => 2508 "Tamanyo" => 397319 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Funduscopic appearance and initial autofluorescence in RE. (A and B) Posterior pole, where discrete hyperemia of the optic disc and alterations of the retinal pigment epithelium (RPE) can be seen. (C and D) Appearance of the temporal periphery, showing yellowish subretinal lesions with cicatricial appearance, as well as diffuse changes in the RPE. (E and F) Funduscopic view of the inferior peripheral retina, with scar-like lesions with pigmentary mobilisation.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Vitreoretinal lymphoma presents as a high-grade extranodal non-Hodgkin lymphoma, mainly of activated B-cell origin. Despite its low incidence, it has seen an increase in recent years as a consequence of increased life expectancy, increased use of immunosuppressants and more accurate diagnostic techniques.</p><p id="par0010" class="elsevierStylePara elsevierViewall">It typically presents with <span class="elsevierStyleItalic">aurora borealis</span> or sheet vitritis accompanied by subepithelial or deep retinal pigmentary infiltrates, and should be suspected in cases of torpid uveitis or uveitis refractory to corticosteroid treatment.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical case</span><p id="par0015" class="elsevierStylePara elsevierViewall">We present the case of a 66-year-old male patient, with no medical history of interest and a farmer, who was referred to our hospital for evaluation of posterior uveitis in the right eye (RE) in relation to possible Lyme disease, given the history of a recent tick bite and compatible complementary tests, such as a positive immunoblot for <span class="elsevierStyleItalic">Borrelia burgdorferi</span>.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient had been treated at his referral hospital with ceftriaxone and oral and intravenous corticosteroids, as well as with oral doxycycline, having presented numerous recurrences after lowering the dose of oral corticosteroid, for which he was referred to our hospital for further evaluation.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The initial examination revealed a visual acuity (VA) of 0.1 in the RE and 1.0 in the left eye (LE), and funduscopy revealed mild vitritis in the RE, optic disc hyperemia and peripheral pigment mobilisation, with the appearance of the LE being normal (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Optical coherence tomography (OCT) showed cystic macular edema (CME) with disruption of the outer layers and choroidal thickening, the OCT of the LE being null. There was also significant thickening of the nerve fibre layer (NLC) in the RE, which was normal in the LE.</p><p id="par0035" class="elsevierStylePara elsevierViewall">A blood count, uremia, creatinine, liver profile, C-reactive protein and angiotensin-converting enzyme, treponemal tests, IgM and IgG serology for toxoplasmosis, human immunodeficiency virus (HIV) serology and Mantoux, as well as complementary tests, including chest X-ray, brain computed axial tomography (CAT) with and without contrast and lumbar puncture, which were also found to be unremarkable. Despite the unilateral nature of the picture and in order to rule out paraneoplastic syndrome, a CT scan of the chest and abdomen, anti-retinal antibodies (anti-recoverin and anti-enolase) and neurophysiological tests (ERG, EOG) were requested. In the absence of results, it was decided to perform an anterior chamber puncture under topical anesthesia to determine the IL-10/IL-6 ratio, which was <1 and therefore not suggestive of lymphoma.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In the presence of recurrences and in order to control the condition, treatment was started with a descending course of oral corticosteroids at a dose of mg/kg/day, with partial remission of the CMD, so it was decided to perform an intravitreal injection of dexamethasone 700 micrograms (Ozurdex®), with a complete response, but with recurrence after 4 months, requiring two additional injections of this drug in the RE. Given the dependency on corticoids and macular involvement, and after the relevant assessment by the internal medicine and preventive medicine services, it was decided to start biological treatment as a corticosteroid-sparing treatment with adalimumab, starting with a load of 80 mg subcutaneously and then 40 mg every 14 days. The patient showed no improvement and was unable to avoid dependence on intravitreal corticosteroids, despite the biologic treatment.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Four months later, the patient presented with myodesopsia in the LE, showing a VA of 0.6 on examination, with funduscopy showing sheet vitritis, yellowish-white subretinal infiltrates in the inferior and nasal retina, some with pigmentary mottling on the surface and the appearance of adjacent flat retinal detachment. OCT again showed CME in the RE, being normal in the LE (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In view of the evidence of vitritis in the oleopharyngeal eye and despite the negative results of the complementary tests performed, vitrectomy and biopsy of the chorioretinal lesion in the LE was decided, after suspending systemic corticosteroid treatment for 7 days.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Vitrectomy 23 G via pars plana was performed under air and at low cutting speed and a sample of undiluted vitreous humour was collected. Subsequently, endolaser was applied to the largest nasal subretinal yellowish focus, and retinotomy was performed on the centre of the focus, aspirating the subretinal content. Flow cytometry was positive for lymphomatous infiltration of type B lymphoma, phenotypically compatible with CD10 large cell lymphoma. In view of the results obtained, the patient was admitted for lumbar puncture, which was negative, including flow cytometry analysis, which was phenotypically normal, ruling out leptomeningeal involvement.</p><p id="par0055" class="elsevierStylePara elsevierViewall">After confirmation of the diagnosis, the patient was referred to the hematology department and treatment was started with intravenous systemic chemotherapy with BRAM (carmustine, methotrexate, ara-C and rituximab). Two months later, VA is 0.3 in AO, and the fundus shows a significant reduction in optic nerve infiltration, with regressive appearance of the lesions, appearance of pigmentary mottling throughout the posterior pole and resolution of the exudative retinal detachment (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">As a result of long-term ocular inflammation, vitrectomy and prolonged treatment with corticosteroids, the patient developed cataracts with a posterior subcapsular component bilaterally, which were operated on, finally achieving 0.7 vision in AO. The VA and the regressive appearance of the lesions were maintained during the 3 years of follow-up, without developing CNS involvement or at any other level.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Recurrent uveitis with partial response to steroid treatment should raise suspicion of vitreoretinal lymphoma, even in the presence of retinal scar lesions as the only finding, as in the present case, especially when the uveitis could not be assessed in the acute phase or was initially treated with steroids.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In case of negative supplementary tests (blood tests, serology, Mantoux, chest X-ray, thoracoabdominal CT and brain MRI), diagnostic vitrectomy for biopsy and cytology of the vitreous sample should be considered. In a high percentage of cases this test is inconclusive, as most patients are on corticosteroid treatment, which masks the diagnosis, so it is essential to reduce or stop steroid treatment weeks before the surgical procedure.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In order to increase the diagnostic yield, an adequate undiluted vitreous sample should also be collected and analysed early, and good communication with the pathologist is essential.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Diagnosis of <span class="elsevierStyleItalic">Borrelia burgdorferi</span> infection is commonly made by serological tests including the indirect fluorescent antibody test (IFAT), whole cell ELISA, Western blot (WB) and a bead-based multiple antigen ELISA assay. Serological interpretation is problematic and focuses on the heterogeneity of assays, the high seroprevalence in endemic areas, the lack of clinical validation of assays in Europe and the presence of diverse <span class="elsevierStyleItalic">Borrelia</span> strains in the US and Europe.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Regardless of methodology, a positive serological test can be interpreted as current or past infection, but has a low positive predictive value for clinical disease. It has not been determined whether prolongation over time of a positive serology is due to persistence of infection, reinfection, exposure or an immune response to <span class="elsevierStyleItalic">Borrelia</span> with continued production of IgG against <span class="elsevierStyleItalic">Borrelia</span> antigens after elimination of the organism.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Positive <span class="elsevierStyleItalic">Borrelia</span> serology results should therefore be interpreted with caution and the possibility of other etiologies should always be kept in mind depending on the clinical appearance and evolution of the patient.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The relevance of the present case lies in its diagnostic challenge, due to the initial absence of typical vitreoretinal lymphoma lesions, manifesting as cicatricial lesions on arrival at our centre as a consequence of previous treatment with corticosteroids. This, added to the positive serological findings for <span class="elsevierStyleItalic">Borrelia burgdorferi</span>, led to an erroneous diagnosis, even leading to the use of biological treatment as a corticosteroid sparing treatment, which masked the process, delaying the appearance of lesions characteristic of vitreoretinal lymphoma and, therefore, the proper diagnosis until after one year.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In this case, the success of the diagnostic vitrectomy is related to the suspension of corticosteroid treatment prior to the intervention, the collection of two samples (one of undiluted vitreous and one of diluted vitreous) and the subsequent retinotomy of the lesion with aspiration of the subretinal material, given that the vitritis was not extensive and the vitreous sample could be insufficient. In addition, an early analysis of the sample was performed after prior communication with the anatomical pathology department, which facilitated the diagnosis.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Vitrectomy is considered the <span class="elsevierStyleItalic">gold standard for</span> the diagnosis of ocular lymphomas, with cytometry having a high positive predictive value, so a positive result will confirm the diagnosis; furthermore, in a high percentage of cases, surgery manages to considerably reduce ocular symptoms.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0095" class="elsevierStylePara elsevierViewall">In cases such as the present one, where there is no evidence of symptoms or signs at the extraocular level, it is essential to make an early diagnosis, allowing early systemic treatment to be initiated in order to avoid potential CNS involvement and thus reduce the morbidity and mortality of the disease.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Funding</span><p id="par0100" class="elsevierStylePara elsevierViewall">This research has not received specific support from public sector agencies, the commercial sector or non-profit organisations.</p></span><span id="sec1025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect3045">Conflict of interests</span><p id="par5100" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres2031067" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1737910" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2031068" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1737909" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusions" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec1025" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-04-18" "fechaAceptado" => "2023-08-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1737910" "palabras" => array:4 [ 0 => "Vitreoretinal lymphoma" 1 => "Posterior uveitis" 2 => "Vitritis" 3 => "Vitrectomy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1737909" "palabras" => array:4 [ 0 => "Linfoma vitreorretiniano" 1 => "Uveítis posterior" 2 => "Vitritis" 3 => "Vitrectomía" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A 66-year-old man with posterior uveitis and recurrent cystic macular edema related to possible previously treated Lyme disease is presented. Due to the recurrence of macular edema despite systemic and local corticosteroid treatment with intravitreal dexamethasone, biological treatment with Adalimumab was established. During follow-up, the patient developed bilateral subretinal lesions compatible with Vitreoretinal Lymphoma (VRL), so vitrectomy was performed, confirming the diagnosis of large B-cell lymphoma.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Treatment with systemic chemotherapy with BRAM-Carmustine, Metrotexate, Ara C, and Rituximab was started with a good answer. Two years later, the patient remains without ocular or systemic recurrences.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Vitreoretinal Lymphoma is a rare type of primary central nervous system lymphoma. The diagnosis is frequently delayed due to the nonspecific symptoms, which mimic chronic posterior uveitis, hence the importance with a diagnostic suspicion.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se presenta el caso de un varón de 66 años remitido por uveítis posterior con edema macular quístico recurrente en relación con posible enfermedad de Lyme previamente tratada. Debido a la recurrencia del edema macular pese al tratamiento corticoideo sistémico y local con dexametasona intravítrea, se instaura tratamiento biológico con Adalimumab. Durante el seguimiento el paciente desarrolla lesiones subretinianas bilaterales compatibles con Linfoma Vitreorretiniano (LVR), por lo que se realiza vitrectomía confirmando el diagnóstico de linfoma de célula B grande.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se inicia tratamiento con quimioterapia sistémica con BRAM- Carmustina, Metrotexate, Ara C y Rituximab, con buena respuesta. Dos años después, el paciente permanece sin recurrencias a nivel ocular ni sistémico.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El Linfoma Vitreoretiniano es un tipo poco frecuente de linfoma primario del sistema nervioso central. El diagnóstico se ve frecuentemente retrasado debido a la inespecificidad de su sintomatología, que simula una uveítis posterior crónica, de ahí la importancia de la sospecha diagnóstica.</p></span>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2590 "Ancho" => 2508 "Tamanyo" => 397319 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Funduscopic appearance and initial autofluorescence in RE. (A and B) Posterior pole, where discrete hyperemia of the optic disc and alterations of the retinal pigment epithelium (RPE) can be seen. (C and D) Appearance of the temporal periphery, showing yellowish subretinal lesions with cicatricial appearance, as well as diffuse changes in the RPE. (E and F) Funduscopic view of the inferior peripheral retina, with scar-like lesions with pigmentary mobilisation.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 798 "Ancho" => 3167 "Tamanyo" => 137904 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Funduscopic and tomographic appearance after debut in an oleopharyngeal eye. (A and B) Funduscopic image reveals inferior subretinal and nasal yellowish-white infiltrates, some with pigmentary mottling. (C) Cystic macular edema with neurosensory detachment in LE.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1627 "Ancho" => 2500 "Tamanyo" => 306989 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Funduscopic and tomographic appearance after 36 months of follow-up. (A and B) Funduscopic image of RE and LE, respectively; after resolution of the process in both eyes, regressive appearance of the lesions and pigmentary mottling is observed throughout the posterior pole. (C and D) Tomographic appearance shows complete resolution of macular edema and subretinal hyperreflective lesions.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bilateral primary ocular lymphoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Sánchez Vega" 1 => "M.A. Reyes Rodriguez" 2 => "F.F. Hernandez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Archivos de la Sociedad Canaria de Oftalmología" "fecha" => "2016" "volumen" => "27" "paginaInicial" => "78" "paginaFinal" => "83" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The diagnostic value of IL-10 and IL-6 level in vitreous fluid and aqueous humor for vitreoretinal lymphoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Chen" 1 => "X. Li" 2 => "D. Wang" 3 => "Y. Ma" 4 => "B. Chen" 5 => "Q. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cca.2020.12.035" "Revista" => array:6 [ "tituloSerie" => "Clin Chim Acta." "fecha" => "2021" "volumen" => "515" "paginaInicial" => "21" "paginaFinal" => "26" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33387464" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consensus recommendations for the diagnosis of vitreoretinal lymphoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Carbonell" 1 => "S. Mahajan" 2 => "S.P. Chee" 3 => "B. Sobolewska" 4 => "R. Agrawal" 5 => "T. Bülow" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ocul Immunol Inflamm" "fecha" => "2021" "volumen" => "29" "paginaInicial" => "507" "paginaFinal" => "520" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary intraocular lymphoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.S. Sagoo" 1 => "H. Mehta" 2 => "A.J. Swampillai" 3 => "V.M.L. Cohen" 4 => "S.Z. Amin" 5 => "P.N. Plowman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Surv Ophthalmol" "fecha" => "2014" "volumen" => "59" "numero" => "5" "paginaInicial" => "503" "paginaFinal" => "516" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The controversies, challenges and complexities of lyme disease: a narrative review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.C. Van Hout" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.18433/jpps30254" "Revista" => array:7 [ "tituloSerie" => "J Pharm Pharm Sci." "fecha" => "2018" "volumen" => "21" "numero" => "1" "paginaInicial" => "429" "paginaFinal" => "436" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30458921" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Borrelia burgdorferi</span> infection and Lyme disease in North American Horses: a consensus statement" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.J. Divers" 1 => "R.B. Gardner" 2 => "J.E. Madigan" 3 => "S.G. Witonsky" 4 => "J.J. Bertone" 5 => "E.L. Swinebroad" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jvim.15042" "Revista" => array:7 [ "tituloSerie" => "J Vet Intern Med." "fecha" => "2018" "volumen" => "32" "numero" => "2" "paginaInicial" => "617" "paginaFinal" => "632" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29469222" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009800000012/v1_202312011130/S2173579423001561/v1_202312011130/en/main.assets" "Apartado" => array:4 [ "identificador" => "5812" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Short communications" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009800000012/v1_202312011130/S2173579423001561/v1_202312011130/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579423001561?idApp=UINPBA00004N" ]
