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Aurora borealis and string of pearls in vitreoretinal lymphoma: patterns of vitreous haze
  1. Alessandro Marchese,
  2. Elisabetta Miserocchi,
  3. Chiara Giuffrè,
  4. Maria Vittoria Cicinelli,
  5. Giuseppe Querques,
  6. Francesco Bandello,
  7. Giulio Modorati
  1. Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
  1. Correspondence to Dr Elisabetta Miserocchi, Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy; miserocchi.elisabetta{at}


Aims Peculiar retinal signs of vitreoretinal lymphoma (VRL) have been identified. However, limited information on the vitreous features of VRL is available. This study aims to characterise the vitreous involvement in VRL with the help of multimodal imaging.

Methods In this retrospective, observational study, we reviewed charts and imaging of all patients with biopsy-proven VRL seen from January 2016 to April 2018 at a single referral centre. These included ultrawide-field imaging, ophthalmic ultrasonography and slit-lamp photography. The main outcome measures were patterns of vitreous haze of VRL, as observed by combining clinical and multimodal imaging information.

Results Twenty-six eyes of 13 patients were included. At presentation, vitreous haze was present in 24 eyes (92%) and was the only sign of VRL in 4 eyes (15%). Three patterns of vitreous haze were identified in VRL. An aurora borealis pattern was present in 12 eyes and showed linear opacities with a myriad of cells aligned along the vitreous fibrils. A string of pearls pattern was present in two eyes at baseline and developed in other four eyes after vitrectomy, showing fine fibrils connecting bunches of inflammatory material. A non-specific pattern was observed in 10 eyes. Ophthalmic ultrasound showed corpuscular material correlating with the grading of vitreous haze.

Conclusion VRL shows different patterns of vitreous haze. Multimodal imaging, including ultrawide-field imaging and slit-lamp photography, helps in recognising these patterns, raising suspicion for VRL.

  • vitreous
  • neoplasia
  • inflammation
  • imaging
  • vitreoretinal lymphoma

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  • Presented at Presented in part as a free paper at the 18th Congress of the European Society of Retina Specialists (EURETINA), Vienna, Austria, 2018.

  • Contributors AM, EM, CG and MVC participated in the planning, conduct and reporting of the work described in the article. GQ, FB and GM participated in the planning and reporting of the work described in the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AM, EM, CG, MVC and GM have no financial disclosures. GQ has the following disclosures: Allergan (S), Alimera (S), Amgen (S), Bayer (S), KHB (S), Novartis (S), Roche (S), Sandoz (S), Zeiss (S); Allergan (C), Alimera (C), Bausch and Lomb (C), Bayer (C), Heidelberg (C), Novartis (C), Zeiss (C). FB has the following disclosures: Allergan (S), Alimera (S), Bayer (S), Farmila-Thea (S), Schering Pharma (S), Sanofi-Aventis (S), Novagali (S), Pharma (S), Hoffmann-La Roche (S), Genentech (S), Novartis (S).

  • Patient consent for publication Obtained.

  • Ethics approval Each subject signed a written consent to participate in the observational studies, gained the approval of the ethics committee of San Raffaele Scientific Institute and adhered to the tenets of the Declaration of Helsinki for research involving human subject.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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