Article Text

Download PDFPDF
Anterior segment involvement in vitreoretinal lymphoma: clinical manifestations, molecular findings and in vivo confocal microscopy
  1. Alessandro Marchese1,2,3,
  2. Carlo Di Biase1,2,4,
  3. Maria Vittoria Cicinelli1,2,
  4. Matteo Menean1,2,
  5. Giulio Ferrari1,2,
  6. Francesco Bandello1,2,
  7. Giulio Modorati1,2,
  8. Debra Anne Goldstein3,
  9. Elisabetta Miserocchi1,2
  1. 1Department of Ophthalmology, San Raffaele Scientific Institute, Milan, Italy
  2. 2School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
  3. 3Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  4. 4Department of Ophthalmology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
  1. Correspondence to Prof. Elisabetta Miserocchi, Department of Ophthalmology, San Raffaele Scientific Institute, Milan, Italy; miserocchi.elisabetta{at}


Background Intermediate and posterior manifestations of vitreoretinal lymphoma (VRL) are well characterised. However, there is limited information on anterior segment involvement in VRL. This study aimed to describe the anterior manifestations of VRL, and their association with molecular testing.

Methods Retrospective analysis of patients with biopsy-proven VRL. Study variables included anterior segment manifestations, findings from slit-lamp photos and in vivo confocal microscopy (IVCM) when available. MYD88 L265P mutation and cytology in the aqueous humour, retinal and systemic findings were also analysed.

Results The analysis included 108 eyes of 55 VRL patients. Anterior segment involvement was present in at least one visit in 55 eyes (51%) of 33 patients (60%); it included keratic precipitates (dendritiform with branching and irregular margins in 33 eyes, dust-like in 16 eyes and large granulomatous in 12 eyes), cells in the anterior chamber (51 eyes) and posterior synechiae (2 eyes). IVCM was available for 41 eyes and showed different morphologies of keratic precipitates, including floral, spikes and mulberry patterns (66%, 56% and 20%, respectively). MYD88 L265P mutation in the aqueous humour was detected in 10/21 (48%) eyes with no anterior segment involvement and 24/37 (65%) eyes with anterior segment involvement.

Conclusions Anterior segment manifestations are often present in VRL and include dendritiform and dust-like keratic precipitates. IVCM in VRL can identify different patterns associated with keratic precipitates. MYD88 L265P mutation in the aqueous humour of VRL patients can also be found in eyes without significant anterior segment involvement.

  • Inflammation
  • Aqueous humour
  • Anterior chamber
  • Imaging

Data availability statement

Data are available on reasonable request.

Statistics from

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.

Data availability statement

Data are available on reasonable request.

View Full Text


  • Contributors Planning and design: AM, GF, DAG and EM. Conduct and reporting: AM, CDB, MM, MVC, GF, GM, DAG and EM. Analysis and interpretation of data: all authors. Critical revision: MVC, GF, FB, GM, DAG and EM. Supervision and guarantor: AM, DAG and EM.

  • 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 FB is consultant for Abbvie, Alimera, Bayer, Boehringer-Ingelheim, Fidia Sooft, Hofmann La, Roche, Novartis, Ntc Pharma, Oxurion Nv, SIFI. All other authors have no relevant competing interests to declare.

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