眼原発悪性リンパ腫症例の検討

Review of primary intraocular lymphoma

要約　目的：眼原発悪性リンパ腫の自験例の統計報告。対象と方法：過去38か月間に横浜市立大学附属病院眼科を受診し，診断的硝子体手術で眼原発悪性リンパ腫と診断された6例を対象とした。結果：男性2例3眼，女性4例6眼で，3例が片眼性，3例が両眼性であった。年齢は62～82歳，平均73歳であり，8～72か月の経過を追った。全例に濃厚な硝子体混濁または眼底に黄白色病巣があった。IL-10対IL-6比は1.3～76.7の範囲にあり，全例が1.0以上であった。硝子体細胞診では全例がⅢb以下であった。経過中に3例に中枢神経系に病変が生じ，全例が死亡した。メトトレキサートの硝子体注射をした1例と無治療の2例には，中枢神経系に発症していない。結論：眼原発悪性リンパ腫では，中枢神経系の発症が生命予後を不良化する。IL-10対IL-6比から中枢神経系の発症の有無または予測はできなかった。

Abstract.　Purpose：To present a review of primary intraocular lymphoma in our institution. Cases：This study was made on 6 cases who received diagnostic vitrectomy and were diagnosed with primary intraocular lymphoma at Yokohama City University Hospital during the past 38 months. Results：The series comprised 2 males and 4 females. Three cases were unilaterally and 3 were bilaterally affected. The age ranged from 62 to 82 years, average 73 years. They were followed up for 8 to 72 months. All the affected eyes showed dense vitreous opacity or retinal exudates. Ratio of IL-10 versus IL-6 ranged from 1.3 to 76.7. All the cases showed lymphoma of class Ⅲb or below by biopsy. Three cases developed involvement of central nervous system（CNS）during the follow-up and resulted in fatal outcome. Two cases refused treatment and one case received intravitreal methotrexate. These 3 cases did not develop CNS involvement. Conclusion：Involvement of CNS results in fatal outcome in primary intraocular lymphoma. Ratio of IL-10 versus IL-6 was not an indicator of CNS involvement.