Bilateral Primary Intraocular Lymphoma

78 year old man with myelodysplasia, was seen with gradual vision loss of 3 months duration left eye worse than right eye. The patient had received prolonged topical steroid therapy without benefit as well as intraocular injections of triamcinolone without effect. The visual acuity was right eye 20/100 vision, left eye hand motions. Examination showed bilateral keratic precipitates. There were vitreous opacities in th right eye, but a view was possible of a tan subretinal infiltrate in the inferotemporal periphery. There was no view to the left fundus due to a dense vitreous infiltrate. CT scan of the brain and spinal cord showed no involvement of these organs. The patient underwent vitrectomy for cytopathology of the left eye. The below photos are from post op. Frame A, blurred due to gas bubble, shows the optic nerve in the black circle, and a subretinal deposit denoted by the black arrow. Frame B, the right eye, shows a more clear subretinal deposit shown by the yellow arrow. Cytopathology showed lymphocytes with nuclear irregularities consistent with lymphoma. The patient was referred for lymphoma staging by PET scan and was begun on twice weekly injections of the vitrous with methotrexate 400 micrograms.