Diagnosis and management of vitreoretinal lymphoma: present and future treatment perspectives

Multimodal imaging in a case of presumed secondary vitreoretinal lymphoma presenting with inner retina and optic nerve head infiltration

“…elevated IL-10:IL-6 ratio, specific gene mutations such as MYD88 and CD79B, immunoglobulin heavy chain gene rearrangement, and B-cell populations by flow cytometry. 9 Aqueous tap can also be used for sampling with sufficient precision, such as in cases when a hypopyon is present or with advanced PCR analysis. 10 , 11 , 12 In our patient, the main site of involvement was an infiltrate of the macula in each eye.…”

“…There is no established treatment regimen for VRL but a variety of protocols have been reported. 9 , 17 , 18 The protocol utilized in this case was weekly injections for four weeks, then injections every two weeks for four cycles, then monthly thereafter. Previous reports have started with intravitreal methotrexate injections twice weekly for four weeks, but our patient had limited transportation to our clinic.…”

“…The primary goals of VRL treatment are to preserve visual function and control intraocular disease, as theoretically, the latter can help to eliminate a potential reservoir that could increase the risk of CNS recurrence. 2 , 9 Combined systemic and intraocular chemotherapy has been shown to yield a higher CNS relapse-free survival but does not seem to affect overall survival. 2 , 22 In the present case, despite apparently good intraocular disease response and systemic treatment, the patient's disease still progressed with the development of brain lesions, which mirrors the current literature and emphasizes the need for better parameters to assess subclinical disease activity.…”

Personalized treatment approaches in intraocular cancer

“…It is specifically characterized by its vitreous and retinal manifestations, distinguishing it from uveal lymphoma, which is subdivided into choroidal, iris, and ciliary body. 19 Patients with vitreoretinal lymphoma often present with symptoms such as blurred vision and floaters, with the disease manifesting as vitreous inflammation or subretinal lesions that resemble leopard pigmentation due to their brown centers and yellow periphery. 20 Diagnosis challenges arise due to its rarity and symptom overlap with other uveal diseases, necessitating evaluations including fluorescein angiography for vascular leakage and optical coherence tomography to monitor subretinal changes.…”