Article Text

PDF
Characteristic optical coherence tomography findings in patients with primary vitreoretinal lymphoma: a novel aid to early diagnosis
  1. Robert J Barry1,2,
  2. Anastasia Tasiopoulou3,
  3. Philip I Murray1,2,
  4. Praveen J Patel3,
  5. Mandeep S Sagoo3,4,
  6. Alastair K Denniston1,5,
  7. Pearse A Keane3
  1. 1Academic Unit of Ophthalmology, University of Birmingham, Birmingham, UK
  2. 2Department of Ophthalmology, Birmingham and Midland Eye Centre, Birmingham, UK
  3. 3NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
  4. 4Department of Oncology, St Bartholomew’s Hospital, London, UK
  5. 5Department of Ophthalmology, Queen Elizabeth Hospital, Birmingham, UK
  1. Correspondence to Dr Pearse A Keane, NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS, London Ec1V 2PD, UK; Pearse.Keane{at}moorfields.nhs.uk

Abstract

Background The diagnosis of primary vitreoretinal lymphoma (PVRL) poses significant difficulties; presenting features are non-specific and confirmation usually necessitates invasive vitreoretinal biopsy. Diagnosis is often delayed, resulting in increased morbidity and mortality. Non-invasive imaging modalities such as spectral domain optical coherence tomography (SD-OCT) offer simple and rapid aids to diagnosis. We present characteristic SD-OCT images of patients with biopsy-positive PVRL and propose a number of typical features, which we believe are useful in identifying these lesions at an early stage.

Methods Medical records of all patients attending Moorfields Eye Hospital between April 2010 and April 2016 with biopsy-positive PVRL were reviewed. Pretreatment SD-OCT images were collected for all eyes and were reviewed independently by two researchers for features suggestive of PVRL.

Results Pretreatment SD-OCT images of 32 eyes of 22 patients with biopsy-proven PVRL were reviewed. Observed features included hyper-reflective subretinal infiltrates (17/32), hyper-reflective infiltration in inner retinal layers (6/32), retinal pigment epithelium (RPE) undulation (5/32), clumps of vitreous cells (5/32) and sub-RPE deposits (3/32). Of these, the hyper-reflective subretinal infiltrates have an appearance unique to PVRL, with features not seen in other diseases.

Conclusion We have identified a range of SD-OCT features, which we believe to be consistent with a diagnosis of PVRL. We propose that the observation of hyper-reflective subretinal infiltrates as described is highly suggestive of PVRL. This case series further demonstrates the utility of SD-OCT as a non-invasive and rapid aid to diagnosis, which may improve both visual outcomes and survival of patients with intraocular malignancies such as PVRL.

  • diagnostic tests/investigation
  • imaging
  • inflammation
  • neoplasia
  • retina

Statistics from Altmetric.com

Footnotes

  • Contributors RJB and AT performed the initial clinical database search, identified confirmed cases of PVRL, collected all pretreatment OCT images and generated descriptive statistics as presented. RJB produced the first draft of the manuscript and figures. All authors contributed to the study conception and design, reviewed the OCT images and statistical analysis and edited the manuscript, contributing to the final approval of the version sent for approval.

  • Competing interests None declared.

  • Ethics approval Moorfields Eye Hospital.

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

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.