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[Natural killer-cell lymphoma of the iris with a normal fundus]
Yoriko Nakanishi1, Kazuaki Miyamoto, Masashi Kikuchi
1Department of Ophthalmology, Kobe City General Hospital, 4-6 Minatojima-nakamachi, Chuo-ku, Kobe 650-0046, Japan.
Background:
Intraocular lymphoma is a relatively uncommon malignancy, rarely presenting with exclusively anterior segment findings in a normal fundus.
Case:
A 38-year-old male, previously diagnosed with nasal lymphoma, currently in complete remission after chemotherapy and radiotherapy, presented with blurring of vision in his left eye, which initially responded to local steroid therapy. However, the patient developed resistance to steroid therapy and developed nodular masses in the left iris. Ultrasound biomicroscopy revealed diffuse thickenings leading to a complex and uneven shape of the left iris. An iris biopsy was done which led to the diagnosis of natural killer(NK)-cell lymphoma. Radiation therapy was instituted which led to rapid resolution of both the nodular masses and iritis.
Conclusion:
This is a case of malignant lymphoma presenting as metastasis to the iris without involvement of the chorioretinal tissues. When encountering a patient with iritis resistant to the steroid therapy, clinical ophthalmologists should consider metastatic malignancy in the differential diagnosis.