Cutaneous T-cell Lymphoma Metastatic to the Retina

      A 50-year-old man with cutaneous T-cell lymphoma (CTCL) complained of painless vision loss in his right eye. He had a large, indurated plaque on his tongue (Fig 1A) whose biopsy showed invasion with neoplastic T-cells (Fig 1B). Vision was count fingers in the right eye, and there was vitritis, retinal vascular sheathing, and a diffuse, white infiltrate in the macula (Fig 1C). Antimicrobials were injected intravitreously without effect. Cultures were negative. Flow cytometry of the vitreous showed monoclonal T cells, consistent with metastatic CTCL. The patient underwent external beam radiotherapy with almost complete resolution of the lesion (Fig 1D). Vision improved to 20/400.