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Doctor Identification CodePatient IdentificationReporting Interval Year/QuarterReporting Interval EvaluationRIGHT Eye InvolvementRight Eye FootRight Eye MetreRight Eye DecimalRight Eye LogMARRight Ocular involvement during reporting intervalRight Eye Other Tissue InputRight Eye Vitrectomy during reporting intervalRight Eye Intravitreal methotrexateRight Eye Number of MTX InjectionsRight Eye MTX Unit Dose [mg/0.1mL]Right Eye Intravitreal rituximabRight Eye Number of RITUX InjectionsRight Eye RITUX Unit Dose [mg/0.1mL]Right Eye Intravitreal melphalanRight Eye Number of melphalan injectionsRight Eye Unit dose of melphalan [ mg/0.1mL ]Right Eye Other Intravitreal DrugRight Eye Other Intravitreal Drug NameRIGHT Eye Number of Other Intravitreal Drug InjectionsRight Eye Unit dose of Other Intravitreal DrugRight Eye other Intravitreal Drug Units (e.g. mg/0.1mL)Right Eye Ocular IrradiationRight Eye Total dose [ Gy ]Right Eye Focal ocular treatment during reporting intervalRight Eye Complications during reporting intervalRight Eye Other complication OR Ocular surgeryRight Eye status at end of reporting intervalRight Eye Status Define ThisLEFT Eye InvolvementLeft Eye FootLeft Eye MetreLeft Eye DecimalLeft Eye LogMARLeft Ocular involvement during reporting intervalLeft Eye Other Tissue InputLeft Eye Vitrectomy during reporting intervalLeft Eye Intravitreal methotrexateLeft Eye Number of MTX InjectionsLeft Eye MTX Unit Dose [mg/0.1mL]Left Eye Intravitreal rituximabLeft Eye Number of RITUX InjectionsLeft Eye RITUX Unit Dose [mg/0.1mL]Left Eye Intravitreal melphalanLeft Eye Number of melphalan injectionsLeft Eye Unit dose of melphalan [ mg/0.1mL ]Left Eye Other Intravitreal DrugLeft Eye Other Intravitreal Drug NameLeft Eye Number of Other Intravitreal Drug injectionsLeft Eye Unit dose of Other Intravitreal drugLeft Eye Other Intravitreal Drug Units (e.g. mg/0.1mL)Left Eye Ocular IrradiationLeft Eye Total dose [ Gy ]Left Eye Focal ocular treatment during reporting intervalLeft Eye Complications during reporting intervalLeft Eye Other complication OR Ocular surgeryLeft Eye status at end of reporting intervalLeft Eye Status Define ThisExtra-ocular involvement at any time during reporting intervalExtra-ocular involvement Other InputExtra-ocular treatment during reporting intervalExtra-ocular Treatment Other InputComplications of extra-ocular treatment during reporting intervalExtra-ocular Treatment Complications Other InputYearsMonthsPatient Status at End of Reporting IntervalCause of deathRevised non-lymphoma diagnosis inputCommentsProgress
Doctor Identification CodePatient IdentificationReporting Interval Year/QuarterReporting Interval EvaluationRIGHT Eye InvolvementRight Eye FootRight Eye MetreRight Eye DecimalRight Eye LogMARRight Ocular involvement during reporting intervalRight Eye Other Tissue InputRight Eye Vitrectomy during reporting intervalRight Eye Intravitreal methotrexateRight Eye Number of MTX InjectionsRight Eye MTX Unit Dose [mg/0.1mL]Right Eye Intravitreal rituximabRight Eye Number of RITUX InjectionsRight Eye RITUX Unit Dose [mg/0.1mL]Right Eye Intravitreal melphalanRight Eye Number of melphalan injectionsRight Eye Unit dose of melphalan [ mg/0.1mL ]Right Eye Other Intravitreal DrugRight Eye Other Intravitreal Drug NameRIGHT Eye Number of Other Intravitreal Drug InjectionsRight Eye Unit dose of Other Intravitreal DrugRight Eye other Intravitreal Drug Units (e.g. mg/0.1mL)Right Eye Ocular IrradiationRight Eye Total dose [ Gy ]Right Eye Focal ocular treatment during reporting intervalRight Eye Complications during reporting intervalRight Eye Other complication OR Ocular surgeryRight Eye status at end of reporting intervalRight Eye Status Define ThisLEFT Eye InvolvementLeft Eye FootLeft Eye MetreLeft Eye DecimalLeft Eye LogMARLeft Ocular involvement during reporting intervalLeft Eye Other Tissue InputLeft Eye Vitrectomy during reporting intervalLeft Eye Intravitreal methotrexateLeft Eye Number of MTX InjectionsLeft Eye MTX Unit Dose [mg/0.1mL]Left Eye Intravitreal rituximabLeft Eye Number of RITUX InjectionsLeft Eye RITUX Unit Dose [mg/0.1mL]Left Eye Intravitreal melphalanLeft Eye Number of melphalan injectionsLeft Eye Unit dose of melphalan [ mg/0.1mL ]Left Eye Other Intravitreal DrugLeft Eye Other Intravitreal Drug NameLeft Eye Number of Other Intravitreal Drug injectionsLeft Eye Unit dose of Other Intravitreal drugLeft Eye Other Intravitreal Drug Units (e.g. mg/0.1mL)Left Eye Ocular IrradiationLeft Eye Total dose [ Gy ]Left Eye Focal ocular treatment during reporting intervalLeft Eye Complications during reporting intervalLeft Eye Other complication OR Ocular surgeryLeft Eye status at end of reporting intervalLeft Eye Status Define ThisExtra-ocular involvement at any time during reporting intervalExtra-ocular involvement Other InputExtra-ocular treatment during reporting intervalExtra-ocular Treatment Other InputComplications of extra-ocular treatment during reporting intervalExtra-ocular Treatment Complications Other InputYearsMonthsPatient Status at End of Reporting IntervalCause of deathRevised non-lymphoma diagnosis inputCommentsProgress