REFERENCES 1. Taylor HR. Eye care for the future: the Weisenfeld Lecture. Invest Ophthalmol Vis Sci 2003;44:1413–1418. 2. Wallace L, Alward M. Frequency doubling technology perim- etry for the detection of glaucomatous visual field loss. Am J Ophthalmol 2000;129:376 –378. 3. Ferraro JG, Mazzoni LL, Keeffe JE, Vu HT, Constantinou M, Taylor HR. Evaluation methodology for a public eye health program: the Vision Initiative Project. Ophthalmic Epide- miol, forthcoming. 4. Garway-Heath DF, Ruben ST, Viswanathan A, Hitchings RA. Vertical cup/disc ratio in relation to optic disc size: its value in the assessment of glaucoma suspect. Br J Ophthalmol 1998;82:1118 –1124. 5. Landis J, Koch G. The measurement of observer agreement for categorical data. Biometrics 1977;33:159 –174. Combined Positron Emission Tomography/Computed Tomography Imaging of Orbital Lymphoma Brian T. Chan-Kai, MD and Michael T. Yen, MD PURPOSE: To report a case of orbital lymphoma with systemic dissemination that was identified and localized by combined positron emission tomography (PET)/com- puted tomography. DESIGN: Case report. METHODS: A 75-year-old woman presented with a 6-month history of painless, progressive fullness of her right upper eyelid. A PET/computed tomography was obtained to provide functional and anatomic assessment of the orbits. An orbitotomy was performed with sub- total excision of the lesion to obtain histologic diagnosis. RESULTS: The PET/computed tomography scan revealed intensive uptake of tracer in a right orbital mass measur- ing 2.3  1.8  2.6 cm. Foci of abnormal tracer uptake were also noted in the right neck, right hilar region, and central abdomen. Histopathologic findings were consis- tent with follicular cell lymphoma. CONCLUSIONS: The combination of PET/computed tomog- raphy provides accurate and precise information in an expedited manner not offered by alternative imaging modal- ities. PET/computed tomography imaging should be consid- ered in the evaluation of orbital neoplasms, especially if lymphoma is suspected. (Am J Ophthalmol 2005;140: 531–533. © 2005 by Elsevier Inc. All rights reserved.) O VER THE PAST DECADE, 18 F-FLUORODEOXYGLUCOSE (FDG) positron emission tomography (PET) has be- come increasingly important in the evaluation and staging of cancer, particularly extra-nodal lymphoma. 1–3 It has the ability to identify foci of abnormally high metabolism, a characteristic associated with malignancy. The major limita- tion of PET imaging is its lack of anatomic detail. 4 Computed tomography imaging provides excellent anatomic detail, but lacks the functional imaging provided by PET scans. Inte- grated PET/computed tomography systems now are able to combine the functional information from PET with the anatomic information of computed tomography. PET/com- puted tomography performs both scans simultaneously at a single sitting, thus enabling accurate superimposition of the two imaging modalities. The result is much greater accuracy than that achieved by performing separate PET and com- puted tomography scans. 3– 6 We report a case of orbital lymphoma in which systemic dissemination was identified and localized by PET/computed tomography. ● CASE REPORT: A 75-year-old woman presented with a 6-month history of painless, progressive fullness of her right upper eyelid (Figure 1). Her past medical history was signif- icant for ovarian cancer successfully treated with oophorec- tomy and radiotherapy to the pelvis. On examination, Hertel exophthalmetry revealed 5 mm of right eye proptosis com- pared with the left eye. Visual acuity was 20/25 and extraoc- ular motility was full in both eyes. The remainder of the ophthalmic examination was unremarkable. A PET/computed tomography was obtained to provide functional and anatomic assessment of the orbits (Figures 2 and 3). The scan revealed intensive uptake of FDG in a right orbital mass measuring 2.3  8  2.6 cm. Additionally, abnormal tracer uptake were also noted in the right neck, right hilar, and central abdomen. A lateral orbitotomy with Accepted for publication Feb 21, 2005. From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas. Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York. Inquiries to Michael T. Yen, MD, Cullen Eye Institute, 6565 Fannin NC-205, Houston, TX 77030; fax: (713) 798-8739; e-mail: myen@ bcm.tmc.edu FIGURE 1. Patient with right orbital lymphoma. A 75-year- old woman with a right orbital mass causing painless fullness of the right upper eyelid. Note the S-shaped contour of the right upper lid as well as the inferior displacement of the globe. BRIEF REPORTS VOL. 140,NO. 3 531