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Clinical features and diagnostic significance of the intraocular fluid of 217 patients with intraocular lymphoma

  • Clinical Investigation
  • Published:
Japanese Journal of Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

Intraocular lymphoma is a rare disease with a poor prognosis. Early diagnosis and early treatment greatly influence the survival prognosis of this disease. This retrospective study aimed to clarify the clinical features of patients diagnosed with intraocular lymphoma, and the diagnostic significance of results from analysis of vitreous samples including cytology, cytokine measurements, and the IgH gene rearrangement test.

Methods

We reviewed 217 patients with intraocular lymphoma diagnosed at 25 medical institutions in Japan. Together with clinical observation, cytological analysis, determination of the levels of cytokines, and/or detection of IgH gene rearrangements were conducted using vitreous fluid specimens. The results were studied in conjunction with clinical findings of intraocular lymphoma. Survival curves were estimated by use of the Kaplan–Meier method.

Results

The subjects comprised 85 men and 132 women, with a mean age at first ophthalmological examination of 63.4 years. The mean observation period was 41.3 months. During the observation period, 69 patients had onset of lymphoma in one eye and 148 had onset in both eyes. Intraocular lymphoma with involvement of the central nervous system (CNS) was most common, found in 60.8 % of the patients, whereas intraocular lymphoma without involvement of other organs was found in 28.1 % of patients. With respect to onset patterns, 82.5 % of patients developed primary ocular lesions whereas 16.1 % developed primary CNS lesions preceding intraocular lymphoma. Blurred vision and ataxia were the most common ocular and extra-ocular symptoms that prompted patients to seek medical examination. Vitreous opacification was the most common ocular finding. The detection rates of malignant cytology, IL-10/IL-6 ratio greater than 1.0, and IgH gene rearrangements in vitreous specimens were 44.5, 91.7, and 80.6 %, respectively, of patients tested. IL-10/IL-6 ratio greater than 1.0 had the highest overall detection rate, and was extremely high (≥90 %) in patients with or without vitreous opacification. The 5-year survival rate was 61.1 %.

Conclusion

Cytokine analysis of vitreous biopsy had the highest detection rate for intraocular lymphoma. This supplementary diagnostic test should be performed frequently to confirm a diagnosis of intraocular lymphoma.

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Acknowledgments

This study was supported in part by a grant from the Japanese Society of Ocular Oncology. This work was supported by the “Strategic Research-Based Support” Project for private universities; with matching funds from MEXT (Ministry of Education, Culture, Sports, and Science), Japan.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku, Tokyo, 160-0023, Japan

    Keisuke Kimura, Yoshihiko Usui & Hiroshi Goto

Authors
  1. Keisuke Kimura
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  2. Yoshihiko Usui
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  3. Hiroshi Goto
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Consortia

The Japanese Intraocular Lymphoma Study Group

Corresponding author

Correspondence to Keisuke Kimura.

Appendix

Appendix

The Japanese Intraocular Lymphoma Study Group in Japan. The following individuals participated in this study.

Central Unit and Writing Committee

Tokyo Medical University Hospital, Tokyo: Keisuke Kimura, Yoshihiko Usui, Hiroshi Goto.

Clinical sites

Kyushu University School of Medical Sciences, Fukuoka: Hiroshi Yoshikawa.

Tokyo Medical and Dental University School of Medicine and Dental Sciences, Tokyo: Sunao Sugita.

Hokkaido University School of Medicine, Hokkaido: Kenichi Nanba.

The University of Tokyo, Tokyo: Toshikatsu Kaburagi.

Osaka University Medical School, Osaka: Nobuyuki Ohguro.

Kyorin University School of Medicine, Tokyo: Annabelle Ayame Okada.

Kurume University School of Medicine, Fukuoka: Sumie Kawahara.

Kobe University School of Medicine, Hyogo: Atsushi Azumi.

Kagoshima University School of Medical and Dental Science, Kagoshima: Taiji Sakamoto.

Fukushima Medical University School of Medicine, Fukushima: Minoru Furuta.

Kanazawa University School of Medical Science, Kanazawa: Masayuki Takahira.

Yamagata University School of Medicine, Yamagata: Hiroshi Takamura.

Niigata University Medical and Dental Hospital, Niigata: Tokuhide Oyama.

Osaka Medical College, Osaka: Nanae Takai.

Tokyo Jikei University School of Medicine, Tokyo: Tsutomu Sakai.

Juntendo University School of Medicine, Tokyo: Akira Murakami.

Kochi University School of Medicine, Kochi: Nobutsugu Hayashi.

Nagoya University School of Medicine, Aichi: Hiroaki Ushida.

Shimane University School of Medicine, Shimane: Tatsuo Kodama.

Gunma University School of Medicine, Gunma: Tomohiro Otani.

Yokohama City University Graduate School of Medicine, Kanagawa: Nobuhisa Mizuki.

Saitama Red Cross Hospital, Saitama: Takayoshi Kojima.

Kinki University School of Medicine, Osaka: Koichi Maruyama.

National Hospital Organization, Nagoya Medical Center, Aichi: Toshinobu Kubota.

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Kimura, K., Usui, Y., Goto, H. et al. Clinical features and diagnostic significance of the intraocular fluid of 217 patients with intraocular lymphoma. Jpn J Ophthalmol 56, 383–389 (2012). https://doi.org/10.1007/s10384-012-0150-7

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  • DOI: https://doi.org/10.1007/s10384-012-0150-7

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