Case summary: The 61 years old woman visitied our clinic because of blurred vision which was started a year ago. In local clinic, she was diagnosed as posterior uveitis in her right eye because of vitreous hazziness and retinal exudates in her right eye. She was treated with steroid therapy and cryotherapy. But, her symptoms and ophthalmologic findings were not subsided. At the first examination, best corrected visual acuity was zero point one in her right eye. No specific abnormal lesion was observed at anterior segment examination in her right eye. On fundus examination, vitreous hazziness and vitreous cell reaction were observed in her right eye. We suspected her as primary central nervous system lymphoma. So, we performed brain MRI to her. At the brain MRI, the mass was observed in her right occipital lobe. The histological result of brain biopsy and vitreous sampling which were achieved during vitrectomy was diffuse large B cell lymphoma. So, we definitely diagnosed her as diffuse large B cell lymphoma. After combination of systemic chemotheray and 8 times intravitreal Methotrexate injection, we could observe clinical remission of intraocular lymphoma in her right eye. After 25 times intravitreal Methotrexate injection, we could not observe any recurrence sign of lymphoma in her right eye.

Conclusions: We differentiated primary central nervous system lymphoma with chronic vitritis or posterior uveitis as neoplastic masquerade syndrome. We could consider intravitreal methotrexate injection with systemic chemotherapy as a treatment of primary intraocular lymphoma.

Ann Optom Contact Lens 2015;14(3):170-175