Multimodal imaging characteristics in eyes with vitreoretinal lymphoma treated with intravitreal rituximab

Rishi, Pukhraj; Maitra, Puja; Das, Kalpita; Rishi, Ekta; Manchegowda, Pradeep T

doi:10.1007/s10792-021-01828-8

Cited by 6 publications

(3 citation statements)

References 21 publications

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“…Given the advances in ultra-wide field imaging to document and follow lesions, complemented by OCT, fundus autofluorescence, and traditional angiography, multimodal imaging is a mainstay for the diagnosis and management of PVRL. There is a continued need for quantitative research using these methods, as well as functional assessments including ERG [ 35 ]. Applying a multimodal approach enhances the physician’s ability to accurately and promptly diagnose PVRL.…”

Section: Discussionmentioning

confidence: 99%

Multimodal diagnostic imaging in primary vitreoretinal lymphoma

Huang

Liao

et al. 2022

Int J Retin Vitr

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Background Primary vitreoretinal lymphoma (PVRL) is an aggressive lymphoma that may present with protean features and represents a diagnostic challenge. Given that patients with PVRL are at high risk of CNS involvement with a high mortality and morbidity rate, prompt diagnosis is crucial to initiate treatment early in the disease course. A multimodality imaging approach including fundus photography, fundus autofluorescence (FAF), optical coherence tomography (OCT), fluorescein and indocyanine angiography, and electroretinography (ERG) can provide information to establish a diagnosis and provide objective measures for management. We review key findings seen via these imaging modalities in patients with PVRL. Observations Fundus photography can highlight commonly seen patterns of PVRL including vitritis, subretinal disease, retinal pigment epithelial (RPE) abnormalities, optic nerve edema, retinal detachment, and less typical retinitis-like lesions. FAF can identify characteristic patterns of hyper- and hypoautofluorescent signal abnormalities in the macula. Spectral-domain OCT will demonstrate vitreous cells, RPE nodularity, and hyperreflectivity of the outer retina. The presence of a hyper-reflective band in the subretinal space and infiltrates between the RPE and Bruch’s membrane can assist in distinguishing PVRL from choroidal lymphoma. Vertical hyperreflective columns (VHRLs) are another pertinent finding that may represent microinfiltrates of the tumor. OCT has proven to be a particularly useful modality in assessing the progress of treatment in PVRL. Fluorescein angiography can show RPE changes, which include granularity, late staining at the RPE level, and blockage. Indocyanine green angiography (ICGA) primarily shows hypocyanescence, which corresponds to PVRL lesions on fundus photography and may occur secondary to loss of RPE and choriocapillaris. Conclusion While PVRL remains a challenging disease to diagnose and follow, the use of a multimodality imaging approach may assist in establishing a diagnosis. Because of the anatomic spaces PVRL may affect, fundus photography, OCT, FAF, angiography, and ERG can identify key characteristics of the disease, differentiate PVRL from other diseases, and provide baseline information for targeted systemic and local therapies. Further assessment of anatomic and functional targets will aid our clinical application of multimodal imaging in the management of PVRL.

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Section: Discussionmentioning

confidence: 99%

Multimodal diagnostic imaging in primary vitreoretinal lymphoma

Huang

Liao

et al. 2022

Int J Retin Vitr

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“…Hypoautofluorescence indicates the presence of intraretinal or subretinal lymphomatous infiltration or RPE atrophy, whereas hyperautofluorescence is correlated with the impairment of lipofuscin metabolism at the RPE level [ 40 , 41 ]. Areas of hypo-AF relate to coalescing RPE holes with surrounding island of hyper-AF corresponding to scrolled RPE have been reported [ 34 ]. These manifestations should be distinguished from areas of disease activity to prevent over-treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Optical coherence tomography (OCT) and the ratio of IL-10 and IL-6 in the intraocular fluid have been reported as objective and repeatable methods to assess the efficacy of treatment [12][13][14][15][16][17]27]. Although several reports have described OCT findings for PVRL [28][29][30][31][32][33][34][35], the sample sizes in most of them were small and the duration of follow-up was short.…”

Section: Introductionmentioning

confidence: 99%

Retinal changes of primary vitreoretinal lymphoma after intravitreal methotrexate

Liu

Chang

2022

BMC Ophthalmol

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Background To identify retinal changes using spectral-domain optical coherence tomography (SD-OCT) and ultra-widefield images in eyes with primary vitreoretinal lymphoma (PVRL) during intravitreal methotrexate (MTX) treatment. Methods This study retrospectively reviewed 111 eyes of 58 patients with vitreous cytology-proven confirmed PVRL, who received intravitreal injections of MTX. Results At the initial visit, the OCT manifestations included vitreous cells (105 eyes, 94.6%), intraretinal infiltration (44 eyes,39.6%), subretinal infiltration (45 eyes, 40.5%,), retinal pigment epithelium (RPE) abnormalities (66 eyes, 59.5%), disruption of the ellipsoid zone (58 eyes, 52.3%), subretinal fluid (4 eyes, 3.6%), RPE detachment (PED) (28 eyes, 25.2%), epiretinal membrane (ERM) (8 eyes, 7.2%), macular edema (10 eyes, 9%). After therapy, tumor regression was achieved in all eyes. Between the initial presentation and regression, the vitreous cells (94.6% vs. 0%, P < 0.001), intraretinal infiltration (39.6% vs. 0%, P < 0.001), RPE abnormalities (59.5% vs.19.8%, P < 0.001), PED (25.2% vs.0%, P < 0.001), and subretinal infiltration (40.5%vs.16.2%, P < 0.001) were significantly reduced. The fundus photography findings all improved after therapy. The mean Logarithm of the Minimum Angle of Resolution (logMAR) for the best corrected visual acuity (BCVA) at presentation was 0.79 ± 0.81 (range, 0–2.9), which improved to 0.70 ± 0.97 (range, 0–2.9, P = 0.01) at the final visit. Conclusions SD-OCT combined with ultra-widefield imaging, which can reflect retinal changes, are valuable tools for monitoring the effect of PVRL treatment.

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Intraocular Lymphoma: Clinical Presentation and Imaging Studies

Chandra

Raval

2023

Essentials in Ophthalmology

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Multimodal imaging characteristics in eyes with vitreoretinal lymphoma treated with intravitreal rituximab

Cited by 6 publications

References 21 publications

Multimodal diagnostic imaging in primary vitreoretinal lymphoma

Multimodal diagnostic imaging in primary vitreoretinal lymphoma

Retinal changes of primary vitreoretinal lymphoma after intravitreal methotrexate

Intraocular Lymphoma: Clinical Presentation and Imaging Studies

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