玻璃体内甲氨蝶呤和全身化疗治疗双侧弥漫性葡萄膜黑色素细胞增生（BDUMP）后黄斑孔闭合

Q3 Medicine

American Journal of Ophthalmology Case Reports Pub Date : 2025-07-08 DOI:10.1016/j.ajoc.2025.102382

Arthur S. Zupelli , Victor C.F. Bellanda , João Victor N. Arcanjo , Fernando Chahud , Raul N.G. Vianna , Rodrigo Jorge

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引用次数: 0

摘要

目的：本报告报告一例罕见的双侧弥漫性葡萄膜黑色素细胞增生（BDUMP）伴黄斑空洞，在玻璃体注射甲氨蝶呤和全身化疗后脉络膜变薄而消失。病例报告一名78岁男性，表现为进行性视力减退、体重明显下降和呼吸困难。眼科检查发现双眼多处黄白色病灶升高，少量玻璃体细胞，左眼见黄斑孔。光学相干断层扫描显示双眼视网膜下积液、高反射病变及后极脉络膜不规则。全身检查发现肺结节，提示进一步检查。胸膜活检显示成熟淋巴细胞弥漫性浸润，CD20和BCL-2阳性，提示边缘区b细胞淋巴瘤。患者接受了全身化疗和超说明书玻璃体内注射甲氨蝶呤。值得注意的是，治疗后左眼黄斑孔自动闭合，视力明显改善。bdump提出了诊断和治疗的挑战，需要多学科的方法。该病例在玻璃体内甲氨蝶呤和脉络膜减薄后黄斑孔闭合的机制值得注意。我们认为全身化疗在眼部症状管理中也发挥了有效的作用。

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Macular hole closure following treatment of bilateral diffuse uveal melanocytic proliferation (BDUMP) with intravitreal methotrexate and systemic chemotherapy

Purpose

This report presents an unusual case of bilateral diffuse uveal melanocytic proliferation (BDUMP) associated with a macular hole that resolved after choroidal thinning following intravitreal methotrexate and systemic chemotherapy.

Case report

A 78-year-old male presented with progressive visual deterioration, significant weight loss and dyspnea. Ophthalmologic examination revealed multiple elevated yellowish-white lesions and few vitreous cells in both eyes, with a macular hole in the left eye. Optical coherence tomography showed subretinal fluid, hyperreflective lesions and choroidal irregularities at posterior pole in both eyes. Systemic screening revealed a pulmonary nodule, prompting further investigation. A pleural biopsy disclosed diffuse infiltration by mature-looking lymphocytes, positive for CD20 and BCL-2, indicating a marginal zone B-cell lymphoma. The patient received systemic chemotherapy and off-label intravitreal methotrexate injections. Notably, the macular hole in the left eye spontaneously closed following treatment, leading to significant visual improvement.

Discussion

BDUMP poses diagnostic and therapeutic challenges necessitating a multidisciplinary approach. This case is notable for the mechanism of macular hole closure after intravitreal methotrexate and choroidal thinning. We believe that systemic chemotherapy also played an effective role in ocular symptoms management.

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来源期刊

American Journal of Ophthalmology Case Reports Medicine-Ophthalmology

CiteScore

2.40

自引率

0.00%

发文量

513

审稿时长

16 weeks

期刊介绍： The American Journal of Ophthalmology Case Reports is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished case report manuscripts directed to ophthalmologists and visual science specialists. The cases shall be challenging and stimulating but shall also be presented in an educational format to engage the readers as if they are working alongside with the caring clinician scientists to manage the patients. Submissions shall be clear, concise, and well-documented reports. Brief reports and case series submissions on specific themes are also very welcome.