Bilateral Central Retinal Vein Occlusion in a Patient with Mantle Cell Lymphoma

Abstract

Background: A Mantle Cell Lymphoma (MCL) is an aggressive B cell lymphoma and accounts for approximately 6% of all non-Hodgkin's lymphomas. A MCL has a poor prognosis with a median survival of about two to five years. We present our findings in a case of bilateral Central Retinal Vein Occlusion (CRVO) that developed in a patient with MCL. Case Presentation:A 70-year-old woman was diagnosed with primary tonsil MCL in March 2009 and progressed to complete remission after chemotherapy. In March 2014, the decimal visual acuity in her right eye decreased to 0.01 due to a CRVO. Although malignant cells were not detected in the cerebrospinal fluid, methotrexate and dexamethasone were injected intraspinally. Two weeks later, the vision in her left eye decreased to 0.03, and she was found to have a CRVO in her left eye. Hematological and systemic evaluations eliminated hypercoagulability and autoimmune disorders. Although MRI and CT showed no central nervous infiltrations, the clinical features suggested that the CRVO was related to the recurrence of the lymphoma. She was treated with an intravitreal injection of anti-VEGF (aflibercept) and panrential photocoagulation. The macula edema improved and neovascular glaucoma was prevented. Her vision did not recover because of the retinal and optic nerve ischemia. Conclusion:Bilateral CRVO can be associated with MCL although it is extremely rare. Nevertheless, clinicians should be aware of this association because a CRVO is a clinical sign of relapsing malignant ocular lymphoma.