Abstract：
BACKGROUND: We describe the outcome of ultra-low-dose radiotherapy plus intravitreal methotrexate and rituximab injections for a patient with primary choroidal lymphoma who presented with nodular conjunctival salmon patches and extensive serous retinal detachment.
METHODS: A 34-year-old Iranian man presented with a nodular patch of bulbar conjunctiva in the right eye, and 1+ vitritis. A nearly complete shallow serous retinal detachment, retinal folds, and multifocal yellow choroidal infiltrates were seen during a fundus examination of the right eye. Enhanced depth imaging optical coherence tomography revealed macular retinal folds and an uneven, undulating, \"seasick\" appearance of the choroidal surface with choriocapillaris compression, intraretinal and subretinal fluid, and clusters of optically dense material at the outer retinal level. An incisional biopsy of the conjunctival lesion confirmed the diagnosis of primary choroidal lymphoma with epibulbar involvement. The patient was treated with ultra-low-dose \"boom-boom\" radiation (4 Gy delivered in two fractions over two consecutive days) as well as intravitreal methotrexate and rituximab injections. After a year, the lesions had completely disappeared, with no adverse effects or recurrence.
CONCLUSIONS: Ultra-low-dose (boom-boom) radiotherapy combined with intravitreal chemotherapy and/or immunotherapy may be an effective treatment for primary choroidal lymphoma with anterior epibulbar extension and diffuse subretinal fluid with favorable response and minimal side effects.
METHODS: A 34-year-old Iranian man presented with a nodular patch of bulbar conjunctiva in the right eye, and 1+ vitritis. A nearly complete shallow serous retinal detachment, retinal folds, and multifocal yellow choroidal infiltrates were seen during a fundus examination of the right eye. Enhanced depth imaging optical coherence tomography revealed macular retinal folds and an uneven, undulating, \"seasick\" appearance of the choroidal surface with choriocapillaris compression, intraretinal and subretinal fluid, and clusters of optically dense material at the outer retinal level. An incisional biopsy of the conjunctival lesion confirmed the diagnosis of primary choroidal lymphoma with epibulbar involvement. The patient was treated with ultra-low-dose \"boom-boom\" radiation (4 Gy delivered in two fractions over two consecutive days) as well as intravitreal methotrexate and rituximab injections. After a year, the lesions had completely disappeared, with no adverse effects or recurrence.
CONCLUSIONS: Ultra-low-dose (boom-boom) radiotherapy combined with intravitreal chemotherapy and/or immunotherapy may be an effective treatment for primary choroidal lymphoma with anterior epibulbar extension and diffuse subretinal fluid with favorable response and minimal side effects.
摘要：
背景：我们描述了超低剂量放疗加玻璃体腔甲氨蝶呤和利妥昔单抗注射治疗原发性脉络膜淋巴瘤的结果，该淋巴瘤表现为结膜结膜鲑鱼斑和广泛的浆液性视网膜脱离。
方法：一名34岁的伊朗男子在右眼出现结节状结膜，和1+玻璃体炎。几乎完全的浅层浆液性视网膜脱离,视网膜褶皱,在右眼眼底检查中发现了多灶性黄色脉络膜浸润。增强的深度成像光学相干断层扫描显示黄斑区视网膜皱褶和不均匀，起伏,脉络膜表面的“晕船”外观，脉络膜毛细血管受压，视网膜内液和视网膜下液，和外部视网膜水平的光学致密物质簇。结膜病变的切开活检证实了原发性脉络膜淋巴瘤的诊断并累及球外。患者接受超低剂量“繁荣”辐射（连续两天分两次递送4Gy）以及玻璃体内甲氨蝶呤和利妥昔单抗注射治疗。一年后,病变完全消失了,无不良反应或复发。
结论：超低剂量（boom-boom）放疗联合玻璃体腔化疗和/或免疫治疗可能是原发性脉络膜淋巴瘤伴前球扩张和弥漫性视网膜下液的有效治疗方法，反应良好，副作用最小。
方法：一名34岁的伊朗男子在右眼出现结节状结膜，和1+玻璃体炎。几乎完全的浅层浆液性视网膜脱离,视网膜褶皱,在右眼眼底检查中发现了多灶性黄色脉络膜浸润。增强的深度成像光学相干断层扫描显示黄斑区视网膜皱褶和不均匀，起伏,脉络膜表面的“晕船”外观，脉络膜毛细血管受压，视网膜内液和视网膜下液，和外部视网膜水平的光学致密物质簇。结膜病变的切开活检证实了原发性脉络膜淋巴瘤的诊断并累及球外。患者接受超低剂量“繁荣”辐射（连续两天分两次递送4Gy）以及玻璃体内甲氨蝶呤和利妥昔单抗注射治疗。一年后,病变完全消失了,无不良反应或复发。
结论：超低剂量（boom-boom）放疗联合玻璃体腔化疗和/或免疫治疗可能是原发性脉络膜淋巴瘤伴前球扩张和弥漫性视网膜下液的有效治疗方法，反应良好，副作用最小。
