Retinal Findings with Multimodal Imaging in Primary Intraocular Lymphoma

Abstract

Purpose: : Primary intraocular lymphoma (PIOL) is a subtype of primary central nervous system lymphoma characterized by a poor prognosis. The aim of this study was to describe multimodal imaging features of PIOL.

Methods: : We retrospectively included patients diagnosed with PIOL examined with near-infrared red reflectance (NIR), fundus autofluorescence (AF), fluorescein angiography (FA), indocyanine green angiography (ICGA) and spectral-domain optical coherence tomography (SD-OCT) by means of confocal scanning laser ophthalmoscope (Spectralis, Heidelberg Engineering, Germany).

Results: : Six patients (10 eyes) were diagnosed with PIOL in 3 different centers. Two eyes were excluded from the analysis due to poor quality images for severe vitreitis.NIR abnormalities were observed in 7/8 eyes and consisted of hyper-reflective dots (7/8eyes) and hyper-reflective lines (1/8 eyes).AF was abnormal in all the eyes examined. We observed hypo-AF dots in all the 8 eyes, hyper-AF dots in 7/8 eyes, hyper-AF lines in 1/8 eyes and hypo-AF confluent areas in 2/8 eyes analyzed.FA showed hyper- and hypo-fluorescent dots in 8/8 and 5/8 eyes respectively.ICGA revealed hypocyanescent dots in 7/8 eyes and late phase hypercyanescent pinpoint in 3/8 eyes.SD-OCT scans of the macular region were performed in all the patients. Six eyes presented with SD-OCT abnormalities, in particular: small PEDs (6/8 eyes), hyper-reflective dots in the outer retina (3/8 eyes), subretinal fluid (2/8 eyes), subretinal material (2/8 eyes) and vitreal hyper-reflective dots (3/8 eyes).Most of the NIR hyper-reflective abnormalities corresponded to the hyper-AF lesions and the hypocyanescent dots, but not to any of the SD-OCT abnormalities.

Conclusions: : Retinal multimodal imaging with confocal scanning laser ophthalmoscope permitted to detect new findings in patients affected by PIOL. This non-invasive method can lead to earlier diagnosis and treatment.

Keywords: imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • retina • oncology