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Ethan K Sobol, David H Abramson, Jasmine H Francis; Fundus Autofluorescence Patterns Before and After Treatment for Primary Vitreoretinal Lymphoma. Invest. Ophthalmol. Vis. Sci. 2020;61(7):5329.
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To evaluate the clinical utility of fundus autofluorescence (FAF) imaging in monitoring disease activity in eyes with primary vitreoretinal lymphoma (VRL). Few studies have focused on identifying FAF characteristics in this condition.
A retrospective chart review was conducted with IRB approval at Memorial Sloan Kettering Cancer Center, identifying eyes diagnosed with VRL that underwent treatment. Only those eyes with adequate imaging before and after treatment were included. Relevant clinical characteristics and demographics were recorded. FAF patterns were graded and categorized as to whether findings correlated with disease activity.
Study criteria were met in 23 eyes (of 18 patients). Mean age was 61 years and 10 (56%) were female. Of the 23 eyes, three (13%) were considered disease recurrences at the time of presentation. Eyes were treated with intravitreal rituximab and methotrexate, external beam radiation, or systemic chemotherapy. An abnormal FAF pattern was identified in 13 eyes (57%), of which 11 (85%) were deemed to correlate with active disease. FAF abnormalities extended beyond the posterior pole into the periphery in eight of 13 eyes (62%). In nine eyes (39%), a granular pattern of hyperautofluorescent foci with adjacent hypoautofluorescence was identified and correlated with sub-retinal pigment epithelial (RPE) deposits and irregularities on ocular coherence tomography (OCT). After treatment, seven (78%) of these eyes had a decrease in granular hyperautofluorescence, with many lesions becoming atrophic and hypoautofluorescent, corresponding to RPE disruption or fibrosis on OCT. Of the remaining two eyes, one had an unchanged FAF pattern at follow up after treatment, and one became uniformly isofluorescent without abnormality. In three eyes, occult lesions not visible on fundoscopy or FAF appeared as hypoautoflourescent lesions after treatment. In the 10 eyes (43%) without baseline FAF findings, vitreous involvement was the primary site of disease activity.
FAF is a useful modality both for diagnostic and disease monitoring purposes. When abnormalities are present, they may correlate with disease activity. Furthermore, findings often exist outside of the posterior pole, suggesting a role for widefield imaging.
This is a 2020 ARVO Annual Meeting abstract.
Representative FAF and fundus photos before (A,B) and after (C,D) treatment.
Corresponding OCT images before (A) and after (B) treatment.
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