case_images: PMC8138215_01
case_images: a Fundus photograph showing subretinal yellowish lesions. b FAF showing hyperfluorescence lesions corresponding to the subretinal yellowish lesions. OCT showing a massive sub-RPE lesion and pre-RPE deposits (horizontal scan (c); vertical scan (d)). FAF, fundus autofluorescence; OCT, optical coherence tomography; RPE, retinal pigment epithelium.
case_images: cop-0012-0277-g01.jpg
case_images: PMC8138215_01_cop-0012-0277-g01.jpg
case_images: F1
case_images: Fundus autofluorescence (FAF) showed multiple hyperfluorescence spots at the first visit (show in Fig. 1). Fig. 2; online suppl. Fig. 1, 2; for all online suppl. material, see www.karger.com/doi/10.1159/000514189).
case_images: Ophthalmologic examination of the unaffected eye (a-e), and the clinical course of PIOL treatment with intravitreal methotrexate (f-t). f Twelve months after the first visit, the subretinal yellowish lesion changed to an atrophic lesion and retinal hemorrhage occurred. g FAF showing change of the hyperfluorescence lesion to a hypofluorescence lesion. h OCT showing intraretinal infiltration, sub-RPE deposits, and disruption of the ellipsoid zone. mfERG showing severe attenuation of response density (i) and ffERG showing subnormal change compared with the unaffected eye (e, j). After treatment with ivMTX, retinal hemorrhage gradually disappeared (k, p). However, the hypofluorescence lesion did not change during the 2 months after starting treatment (l, q). OCT showed disappearance of intraretinal infiltration and recovery of the foveal ellipsoid and interdigitation zone (m, r). At the same time, mfERG showing recovery of central response density (n, s). However, the response of ffERG gradually decreased after treatment (o, t). PIOL, primary intraocular lymphoma; FAF, fundus autofluorescence; RPE, retinal pigment epithelium; OCT, optical coherence tomography; mfERG, multifocal electroretinogram; ffERG, full-field electroretinogram; ivMTX, intravitreal methotrexate.
case_images: cop-0012-0277-g02.jpg
case_images: PMC8138215_01_cop-0012-0277-g02.jpg
case_images: F2
case_images: The subretinal yellowish lesion was atrophic and FAF showed hypofluorescence spots (shown in Fig. 2). Fig. 2; online suppl. Fig. 1, 2; for all online suppl. material, see www.karger.com/doi/10.1159/000514189). OCT showed disseminated areas of RPE atrophy, a disorganized outer retinal layer, and macular edema (shown in Fig. 2). ivMTX (400 mug/0.1 mL) was administered once a week for 2 months as a loading dose and then once a month for 12 months as a maintenance dose. Over the month following the first dose of ivMTX, the subretinal yellowish lesion and intraretinal infiltration gradually disappeared (shown in Fig. 2). However, the amplitude of a- and b-waves on ffERG gradually decreased (shown in Fig. 2, 3).
case_images: mfERG recorded with skin electrodes at the center of the fovea covering a visual field of 30 . A response density of the whole area (a) and central area (d) were analyzed to compare the amplitude and implicit time before (Pre) and after treatment (1 and 2 months after treatments) (b, c, e, f). The implicit time of N1 and P1 recovered to levels as were seen for the unaffected eye (c, f). The amplitude of N1 and P1 did not reach the values as were seen for the unaffected eye (b, e). mfERG, multifocal electroretinogram.
case_images: cop-0012-0277-g03.jpg
case_images: PMC8138215_01_cop-0012-0277-g03.jpg
case_images: F3
case_images: However, the amplitude of a- and b-waves on ffERG gradually decreased (shown in Fig. 2, 3).