Romanian journal of ophthalmology最新文献

{"title":"Gouty tophus on the eyelid.","authors":"Benyamin Leon Anavi, Nina Staneva Stoyanova","doi":"10.22336/rjo.2026.43","DOIUrl":"10.22336/rjo.2026.43","url":null,"abstract":"<p><p>A gouty tophus on the eyelid is a casuistic flash in the routine biopsy flow. There has been a 12th case reported in the literature, along with an analysis of the distribution by age, sex, location, size, and symptoms. Male gender predominates (10:2) within a wide age range (26-79 years), after a several-year history of gout, affecting mainly the canthi and, in only 4 cases, the middle area of the eyelids (the upper eyelid more often), with dimensions ranging from 4 to 14 mm. The tophi can be multiple (in 2 cases). In addition to aesthetic concerns and discomfort, the tophi caused mechanical ptosis of the eyelid on two occasions. A histologically confirmed eyelid tophus may serve as an early diagnostic stigma of the disease, even in the absence of hyperuricemia. Their occurrence may be either a manifestation of disseminated skin tophi or a localized disturbance of the protective alkaline homeostasis of the eyelid tissue.</p>","PeriodicalId":94355,"journal":{"name":"Romanian journal of ophthalmology","volume":"70 2","pages":"322-325"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Ocular ischemia in a patient with Takayasu arteritis.","authors":"Neha Neha, Nripen Gaur, Lokesh Rana, Chakit Kumar","doi":"10.22336/rjo.2026.45","DOIUrl":"10.22336/rjo.2026.45","url":null,"abstract":"<p><strong>Objective: </strong>To describe a rare case of bilateral ocular ischemia as the initial presentation of Takayasu arteritis and highlight the role of early recognition and treatment in preventing irreversible vision loss.</p><p><strong>Methods: </strong>A woman in her 50s presented with a gradual, progressive diminution of vision, initially in the left eye and later involving the right. Comprehensive ophthalmic evaluation, systemic examination, fundus fluorescein angiography, and CT angiography of the head and neck were performed. Laboratory investigations, including ESR, CRP, and ANA, were obtained. The American College of Rheumatology (ACR) criteria were applied to support the diagnosis.</p><p><strong>Results: </strong>The patient demonstrated severe ocular ischemic features, including attenuated retinal vessels, disc neovascularization, and intumescent cataract in the left eye. Systemic examination revealed feeble brachial and radial pulses with a significant inter-arm blood pressure difference. CT angiography showed narrowing of the right common carotid artery and non-opacification of both subclavian arteries. Laboratory findings revealed elevated ESR and CRP, with a positive ANA. Based on clinical, radiologic, and laboratory features, a diagnosis of bilateral ocular ischemia secondary to Takayasu arteritis was made. The patient was treated with oral corticosteroids (60 mg/day, tapered) and azathioprine. At 4 weeks, visual acuity improved to 6/36 in the right eye, while no improvement was noted in the left eye.</p><p><strong>Discussion: </strong>Our case highlights bilateral ocular ischemia as an uncommon but vision-threatening manifestation of Takayasu arteritis. Ocular findings such as retinal vascular attenuation, disc neovascularization, delayed choroidal filling, and peripheral capillary non-perfusion may precede the diagnosis of systemic vasculitis. Recognition of associated systemic signs, including pulse deficits and inter-arm blood pressure discrepancies, facilitated timely diagnosis. Prompt initiation of corticosteroid and immunosuppressive therapy led to visual improvement in the right eye, underscoring the importance of early diagnosis and multidisciplinary management to prevent irreversible visual loss and systemic vascular complications.</p><p><strong>Conclusion: </strong>Bilateral ocular ischemia may be the first manifestation of Takayasu arteritis. This case underscores the importance of a high index of suspicion in patients with unexplained ischemic ocular features. Early systemic evaluation and prompt initiation of immunosuppressive therapy are essential to preserve vision and prevent further vascular complications.</p>","PeriodicalId":94355,"journal":{"name":"Romanian journal of ophthalmology","volume":"70 2","pages":"330-333"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corneal Endothelial Pathology and Thickening in Early Diabetes Mellitus.","authors":"Konstantin Gushansky, Anry Pitchkhadze","doi":"10.22336/rjo.2026.35","DOIUrl":"10.22336/rjo.2026.35","url":null,"abstract":"<p><strong>Purpose: </strong>To compare endothelial cell properties and central corneal thickness (CCT) between nondiabetic individuals and patients with early type 2 diabetes mellitus (T2DM) with good glycemic control.</p><p><strong>Methods: </strong>This retrospective case-control study included patients diagnosed with T2DM within the past 10 years and nondiabetic individuals. All participants underwent comprehensive ocular examination and specular microscopy to measure endothelial cell density (ECD), central corneal thickness (CCT), and coefficient of variation (CV). Intergroup differences were analyzed statistically.</p><p><strong>Results: </strong>A total of 312 eyes from 180 patients were included: 118 eyes in the diabetic group and 194 in the nondiabetic group. There were no significant differences in age (p = 0.08) or sex distribution (p = 0.49) between groups. The diabetic group had a significantly lower mean ECD compared with controls (2467.8 ± 334.5 vs. 2553.5 ± 289.2; p = 0.028) and a significantly higher CCT (558.8 ± 48.8 vs. 547.1 ± 44.6; p = 0.034). No significant difference was observed in the coefficient of variation.</p><p><strong>Discussion: </strong>These findings suggest that corneal endothelial alterations may occur early in the course of type 2 diabetes mellitus, even in patients with good glycemic control and short disease duration. The observed reduction in endothelial cell density alongside increased central corneal thickness may reflect subclinical endothelial dysfunction or early metabolic effects on corneal hydration regulation, preceding overt clinical corneal disease.</p><p><strong>Conclusions: </strong>Early T2DM is associated with reduced ECD and increased CCT compared with nondiabetic individuals, despite good glycemic control. These results indicate that diabetes may affect corneal endothelial structure and function at an early stage.</p>","PeriodicalId":94355,"journal":{"name":"Romanian journal of ophthalmology","volume":"70 2","pages":"267-271"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Blindness Due to Radiation-Induced Optic Neuropathy in a Patient with Nasal Mucosal Melanoma.","authors":"Mauricio Agustin Benetti, Luciana León-Cejas, Luis Ariel Miquelini, Dolores Ribero-Ayerza, Francisco Caiza-Zambrano, Ricardo Reisin","doi":"10.22336/rjo.2026.47","DOIUrl":"10.22336/rjo.2026.47","url":null,"abstract":"<p><p>Radiation-induced optic neuropathy is an uncommon but devastating complication of radiotherapy for head and neck tumors, characterized by subacute, painless, irreversible visual loss. Nasal mucosal melanoma, although rare, carries a high risk of visual pathway toxicity due to its proximity to anterior optic structures. We report the case of a 73-year-old woman with right nasal mucosal melanoma treated with adjuvant radiotherapy (66 Gy) and anti-PD1 immunotherapy, who developed progressive bilateral vision loss. Neuro-ophthalmological examination revealed severe visual acuity reduction, bilateral mydriasis, and optic disc pallor. Optical coherence tomography showed retinal nerve fiber layer thinning. Brain MRI demonstrated contrast enhancement of the optic chiasm and prechiasmatic optic nerves. Despite intensive treatment, the patient progressed to bilateral blindness. This case underscores the importance of early recognition of radiation-induced optic neuropathy, particularly in high-risk anatomical sites and in patients receiving radiotherapy combined with immunotherapy.</p>","PeriodicalId":94355,"journal":{"name":"Romanian journal of ophthalmology","volume":"70 2","pages":"338-342"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Visual, Refractive, and Astigmatism Vector Outcomes of StreamLight Trans-PRK for High Astigmatism (≥ 2.00 D).","authors":"Silvia Victoria Prodescu, Paul Filip Curcă, Călin Petru Tătaru, Cătălina Ioana Tătaru","doi":"10.22336/rjo.2026.32","DOIUrl":"10.22336/rjo.2026.32","url":null,"abstract":"<p><strong>Objective: </strong>To report the early refractive, visual, and astigmatic-vector outcomes of single-step StreamLight™ transepithelial photorefractive keratectomy (Trans-PRK) on the WaveLight EX500 platform in eyes with high preoperative astigmatism (≥ 2.00 dioptres, D).</p><p><strong>Methods: </strong>Single-centre cohort study of 171 consecutive eyes of 107 patients (mean age 27.87 ± 6.56 years; 37.4% female) treated by a single surgeon. Astigmatic outcomes were analyzed by the Alpins method at the corneal plane. A subset of 57 eyes with a mean follow-up of 10.3 ± 7.4 months underwent stability sub-analysis.</p><p><strong>Results: </strong>Mean preoperative cylinder was 3.29 ± 0.81 D and mean spherical equivalent (SE) was -2.73 ± 2.56 D. At one month, mean UDVA was 0.05 ± 0.09 logMAR, mean residual cylinder was 0.65 ± 0.44 D, and mean SE was -0.22 ± 0.47 D. SE was within ±0.50 D of intended in 71.3% of eyes; cylinder was ≤ 0.50 D in 53.2%. Mean efficacy and safety indices were 1.04 ± 0.22 and 1.10 ± 0.22, respectively, with no eye losing two or more lines of CDVA. Vector analysis yielded a correction index of 1.09 ± 0.16, an index of success of 0.21 ± 0.14, and 99% of eyes within ±15° of the intended axis. Stability sub-analysis showed minimal change in SE and an unchanged cylinder between 1 month and a mean follow-up of 10.3 ± 7.4 months (SE -0.14 to -0.07 D).</p><p><strong>Discussion: </strong>Trans-PRK delivered good early visual, refractive, and astigmatic vector outcomes. Axis precision was high with a mean angle of error of -0.81 ± 5.32°, 80% of eyes within ±5°, and 99% within ±15° of the intended axis. Interpretation of vectorial results is subject to the specificity of the 1-month post-Trans-PRK central epithelial thickness (CET decreases in the first week, returns to baseline at 1 month, and progressively increases up to 6 months).</p><p><strong>Conclusions: </strong>Single-step StreamLight™ Trans-PRK on the WaveLight EX500 platform achieves favorable early refractive, visual, and vector-analytic outcomes in eyes with high preoperative astigmatism, with corneal-plane vector parameters that compare favorably with those reported in the published Trans-PRK literature.</p>","PeriodicalId":94355,"journal":{"name":"Romanian journal of ophthalmology","volume":"70 2","pages":"233-248"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personalized Orbital Fracture Repair: Enhancing 3D-Printed Titanium Mesh with Biomimetic 3D-Printed HAP-COL Frameworks.","authors":"Ovidiu Lazăr, Sînziana Istrate, Alina Popa-Cherecheanu, Laura-Mădălina Cursaru, Diana Popescu, Ana Maria Catrina, Cerasela Hăidoiu, Vladimir Suhăianu, Seclaman Edward, Istetia Rami","doi":"10.22336/rjo.2026.33","DOIUrl":"10.22336/rjo.2026.33","url":null,"abstract":"<p><strong>Objective: </strong>Orbital wall fractures require precise reconstruction to restore orbital volume and visual function, and bio-inert titanium implants benefit substantially from osteoconductive surface modifications. This study evaluated the biocompatibility and osteogenic potential of hydroxyapatite-collagen (HAP-COL) composites used in titanium implants intended for orbital fracture repair, comparing a sprayed HAP coating with a robocasting-deposited, 3D-printed HAP-COL layer.</p><p><strong>Methods: </strong>HAp-COL hybrid powder (HAp:COL mass ratio 4:1) was prepared by hydrothermal synthesis at 100 °C and 10⁴ Pa, followed by spray drying, and characterized by FAAS, ICP-OES, FT-IR, XRD, and SEM-EDS. Two implant configurations were tested: Sample 1 (titanium with sprayed HAp) and Sample 2 (titanium with three robocasting-deposited 3D-printed HAP-COL layers). Cytotoxicity was assessed on a normal human osteoblast cell line (NHOst, Lonza CC-2538) in accordance with ISO 10993-12, using sample extracts at stock concentration and binary dilutions (1/2, 1/4, 1/8) and quantified by MTT assay at 24 and 48 hours.</p><p><strong>Results: </strong>Both samples showed dose- and time-dependent viability profiles within the acceptable limits of ISO 10993-5. Sample 1 viability ranged from 70.62% (stock) to 89.72% (1/8) at 24 h, and from 77.28% to 93.63% at 48 h. Sample 2 consistently outperformed Sample 1, with values from 80.61% to 91.28% at 24 h and from 83.35% to 96.47% at 48 h.</p><p><strong>Discussion: </strong>Both HAP-COL application techniques proved highly biocompatible and compliant with ISO 10993-5 non-cytotoxic safety limits. However, the 3D-printed robocast layer (Sample 2) consistently outperformed the sprayed coating, exhibiting superior osteoblast viability and proliferation. This demonstrates that a layered, biomimetic robocast architecture optimizes cell survival and successfully mitigates the bio-inert properties of standard titanium.</p><p><strong>Conclusions: </strong>The 3D-printed HAP-COL coating produced by robocasting exhibited superior biocompatibility and osteoconductive behavior compared with the sprayed alternative, supporting sustained osteoblast proliferation. HAP-COL robocast layers on titanium represent promising candidates for personalized orbital wall reconstruction, although in vivo validation remains necessary.</p>","PeriodicalId":94355,"journal":{"name":"Romanian journal of ophthalmology","volume":"70 2","pages":"249-258"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Visual Profile in Pediatric Scoliosis: Insights from a Controlled Comparative Study.","authors":"Iulian Manac, Sanda Jurja, Nicoleta Leopa, Florina Anca Manac, Traian Virgiliu Surdu, Monica Surdu, Ioana Georgia Oglindă, Alexandru Vicențiu Vâlcu, Stere Popescu, Florin Daniel Enache","doi":"10.22336/rjo.2026.30","DOIUrl":"10.22336/rjo.2026.30","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic scoliosis is a complex spinal deformity that often emerges during growth and has a multifactorial etiology. Recent evidence suggests that visual disturbances may affect postural alignment and potentially influence spinal curvature patterns. However, the relationship between visual impairments and scoliosis, especially S-shaped curves, remains insufficiently understood. The aim was to investigate the association between visual disturbances and spinal curvature characteristics in pediatric patients with double major idiopathic scoliosis, and to explore the correlation between visual status and selected metabolic biomarkers.</p><p><strong>Materials and methods: </strong>This retrospective controlled study included 73 pediatric patients under the age of 16, diagnosed with double major idiopathic scoliosis between January 2020 and 2025. Patients were divided into two groups: 38 with visual disturbances (myopia, hypermetropia, astigmatism, strabismus, or partial blindness) and 35 without visual impairments (control group). Radiographic parameters, clinical characteristics, and biochemical markers were analyzed using univariate and multivariate statistical methods.</p><p><strong>Results: </strong>Patients with visual disturbances exhibited a significantly more cranial thoracic apical vertebra level (T6 vs. T8, p < 0.01), greater thoracic Cobb angles, and lower mean serum calcium and magnesium levels compared with the control group (<i>p</i> < 0.05). Multinomial logistic regression showed that hypomagnesemia and earlier thoracic apical vertebra level were independently associated with visual disturbances.</p><p><strong>Discussion: </strong>The present study provides preliminary evidence that visual disturbances may be associated with specific spinal and metabolic characteristics in children with idiopathic double-curve scoliosis. Although causal relationships cannot be established, these findings support further investigation of visual assessment as a potential component of multidisciplinary scoliosis evaluation and early screening strategies.</p><p><strong>Conclusions: </strong>Visual impairments in pediatric patients with double major idiopathic scoliosis are associated with altered spinal morphology and lower calcium-magnesium levels. These findings support the potential role of visual and metabolic screening in the comprehensive assessment and management of scoliosis.</p>","PeriodicalId":94355,"journal":{"name":"Romanian journal of ophthalmology","volume":"70 2","pages":"216-224"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ocular leptospirosis as the sole clinical manifestation in a pediatric patient: an atypical case.","authors":"Marta Moro-Muniz, Javier Cañas Costa, Honorio Barranco González, Amparo Ortiz-Seller","doi":"10.22336/rjo.2026.41","DOIUrl":"10.22336/rjo.2026.41","url":null,"abstract":"<p><strong>Objective: </strong>To describe an atypical presentation of ocular leptospirosis in a pediatric patient without systemic symptoms, highlighting its diagnostic challenges and therapeutic approach.</p><p><strong>Case presentation: </strong>A 9-year-old previously healthy girl presented with unilateral papillitis and vitritis, progressing to 360º retinal vasculitis as the sole manifestation of subclinical leptospirosis. Serology was positive for Leptospira spp. (IgM and IgG), although PCR testing in aqueous humor and urine was negative. The condition was interpreted as a post-infectious immune-mediated response. Treatment included systemic corticosteroids, intravenous ceftriaxone, and intravitreal triamcinolone, resulting in complete anatomical and visual recovery.</p><p><strong>Discussion: </strong>Ocular leptospirosis can appear as an isolated manifestation in the immune phase of infection, even in the absence of general symptoms or epidemiological evidence. Pediatric cases are rare and often underdiagnosed due to the negative microbiological tests in late stages. This case also highlights the importance of considering environmental exposures, such as flooding, as potential risk factors.</p><p><strong>Conclusion: </strong>This case underlines the need to include leptospirosis in the differential diagnosis of posterior uveitis and papillitis of unknown origin in children. Early multidisciplinary management and appropriate immunomodulatory treatment can prevent permanent visual sequelae.</p>","PeriodicalId":94355,"journal":{"name":"Romanian journal of ophthalmology","volume":"70 2","pages":"311-315"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The great masquerader: primary vitreoretinal lymphoma presenting as white dot syndrome.","authors":"Mihai Luca Cioboată, Ioana Tofolean, Suher Abduraman, Bogdana Maliș, Radu Burcea, Miruna Cioboată","doi":"10.22336/rjo.2026.40","DOIUrl":"10.22336/rjo.2026.40","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Primary vitreoretinal lymphoma (PVRL) is a rare and aggressive subtype of intraocular lymphoma, most commonly associated with primary central nervous system lymphoma (PCNSL). It frequently mimics inflammatory retinal diseases and is therefore considered an important masquerade syndrome in ophthalmology. Early diagnosis remains challenging because clinical manifestations can resemble entities within the white dot syndromes (WDS) spectrum. We report a case initially diagnosed as white dot syndrome, followed by the diagnosis of PCNSL, in which later ocular progression led to the diagnosis of PVRL.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case presentation: &lt;/strong&gt;A 57-year-old male presented with painless, progressive visual loss in the left eye (LE) starting in July 2021. At that time, he was diagnosed at another center with multiple evanescent white dot syndrome (MEWDS) and treated with systemic corticosteroids, with subsequent improvement of visual symptoms after a single treatment course. His medical history was significant for COVID-19 infection in September 2021, followed one month later by neurological symptoms. Brain imaging revealed a left frontal tumor, and surgical resection established the diagnosis of PCNSL (non-Hodgkin B-cell lymphoma). The patient subsequently underwent systemic and intrathecal methotrexate (MTX) therapy combined with whole-brain radiotherapy. One year later, ophthalmologic reevaluation at our center revealed a best-corrected visual acuity (BCVA) of 20/20 in the right eye (RE) and motion in the left eye (LE). The LE showed a relative afferent pupillary defect (RAPD), vitreous cells, and multiple subretinal white-yellow lesions, including subfoveal involvement, associated with peripheral pigmentary changes. Given the patient's medical history, the findings raised suspicion for intraocular lymphoma. A diagnostic vitrectomy was subsequently performed, confirming PVRL. Intravitreal MTX therapy was initiated. Despite treatment, BCVA in the LE was counting fingers, and extensive chorioretinal atrophy was observed. Although subtle changes in the central outer retinal layers were observed in the RE, BCVA was 20/25. The patient subsequently underwent autologous stem cell transplantation. However, the clinical course was further complicated by a relapse of PCNSL and a severe Escherichia coli sepsis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Primary vitreoretinal lymphoma is well known for its ability to masquerade as chronic posterior uveitis or inflammatory chorioretinal diseases, including WDS. The presence of vitritis combined with multifocal subretinal infiltrates should raise suspicion, particularly in patients with a history of PCNSL. Corticosteroid responsiveness may further obscure the diagnosis by temporarily improving inflammatory-like manifestations. Because up to 80% of patients with PVRL develop CNS involvement or present with CNS disease first, ophthalmologic surveillance is essential. Multimodal imaging and a h","PeriodicalId":94355,"journal":{"name":"Romanian journal of ophthalmology","volume":"70 2","pages":"305-310"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic and therapeutic challenges in primary vitreoretinal lymphoma: a practical clinical approach.","authors":"Mihai Luca Cioboată, Ioana Tofolean, Suher Abduraman, Bogdana Maliș, Radu Burcea, Miruna Cioboată","doi":"10.22336/rjo.2026.29","DOIUrl":"10.22336/rjo.2026.29","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Primary vitreoretinal lymphoma (PVRL) is a rare but aggressive subtype of extranodal diffuse large B-cell lymphoma and is closely related to primary central nervous system lymphoma (PCNSL). Its ability to masquerade as chronic posterior uveitis frequently leads to delayed diagnosis and inappropriate treatment, with significant prognostic implications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A narrative review was performed following a comprehensive search of the PubMed/MEDLINE and Cochrane Library databases, encompassing publications from 2000 through 2025 and including randomized controlled trials, observational studies, prospective and retrospective studies, and systematic reviews. The search strategy incorporated the following keywords: \"primary vitreoretinal lymphoma\", \"intraocular lymphoma\", \"diagnostic vitrectomy\", \"MYD88 mutation\", \"IL-10/IL-6 ratio\", \"intravitreal methotrexate\", \"rituximab\", \"CNS involvement\", \"optical coherence tomography\". Two authors independently conducted study selection and eligibility assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Heightened clinical awareness remains pivotal for diagnosing PVRL, particularly when vitritis is partially responsive to steroids, when involvement is bilateral or asymmetric, and when subretinal pigment epithelial infiltrates are present. Multimodal imaging - including optical coherence tomography (OCT), fundus autofluorescence (FAF), and fluorescein angiography (FA) - facilitates early recognition and supports clinical suspicion. Diagnostic vitrectomy with cytology, immunohistochemistry, cytokine analysis (IL-10/IL-6 ratio), and molecular testing (IgH rearrangement, MYD88 L265P mutation) significantly increases diagnostic accuracy. Due to the strong association with central nervous system (CNS) involvement, neuroimaging is mandatory at diagnosis and during follow-up. Treatment options include intravitreal methotrexate and/or rituximab, systemic high-dose methotrexate-based chemotherapy, and radiotherapy. Emerging therapies in PVRL focus on targeted agents, including intravitreal biologics, BTK inhibitors, and personalized molecular-based treatments. The optimal strategy remains controversial and should be individualized based on CNS status and patient characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Primary vitreoretinal lymphoma remains a diagnostic challenge due to its ability to mimic chronic inflammatory eye disorders and the frequent delay in establishing a definitive diagnosis. The integration of multimodal imaging, vitreous cytology, immunohistochemistry, cytokine profiling, and molecular testing has significantly improved diagnostic accuracy. However, management remains complex because of the close association with CNS involvement and the absence of universally accepted treatment protocols. Current therapeutic approaches, including intravitreal chemotherapy, systemic methotrexate-based regimens, and targeted therapies, require individualized selection bas","PeriodicalId":94355,"journal":{"name":"Romanian journal of ophthalmology","volume":"70 2","pages":"204-215"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}