Characteristic optical coherence tomography findings in a case series of patients with primary vitreoretinal lymphoma: A novel aid to early diagnosis.

Abstract

Purpose : The diagnosis of primary vitreoretinal lymphoma (PVRL) poses significant difficulties; presenting features are non-specific and confirmation of diagnosis usually necessitates vitreoretinal biopsy. Diagnosis is therefore often delayed, resulting in increased morbidity and mortality for the patient. Non-invasive imaging modalities such as spectral domain optical coherence tomography (SD-OCT) offer simple and rapid aids to diagnosis. We wish to present characteristic SD-OCT images of patients with biopsy-proven PVRL and propose typical features that may be useful in detecting these lesions at an early stage.

Methods : Patients were identified by retrospective review of electronic patient records attending Moorfields Eye Hospital between April 2010 and April 2016. Records were searched for the term ‘lymphoma’; all returned results were manually reviewed. Pre-treatment SD-OCT images were obtained for all eyes, and were reviewed independently by two researchers for features suggestive of PVRL.

Results : Pre-treatment SD-OCT findings of 32 eyes of 22 patients with biopsy-proven PVRL were reviewed. 17/32(53%) eyes displayed subretinal hyper-reflective infiltrates, either in the form of a band or nodules, accompanied by disruption of the photoreceptor inner segment/outer segment junction. In 10/32 (31%) eyes, these lesions were in the form of band and in 7/32(22%) eyes in the form of nodules. 3/32(9%) eyes showed sub-retinal pigment epithelial (sub-RPE) deposits with steep elevation of the RPE, consistent with sub-RPE mass. Also, 3/32(9%) eyes displayed hyper-reflective foci in the choroid, whilst 6/32(19%) eyes hyper-reflective infiltration in the inner retina layers(ganglion cell and inner plexiform layer).

Conclusions : We have identified a range of SD-OCT findings which we believe to be consistent with a diagnosis of PVRL. We propose that the finding of hyper-reflective subretinal infiltrates is particularly suggestive of PVRL. This case series further demonstrates the utility of SD-OCT as a non-invasive aid to diagnosis, which may improve both visual outcomes and survival of patients with PVRL.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

SD-OCT image in a man with PVRL. Hyper-reflective infiltrates at the level of RPE in the form of bands .

 

SD-OCT image in a man with PVRL. Hyper-reflective infiltrates at the level of RPE in the form of band and nodules and hyper-reflective foci in the choroid.