Optical Coherence Tomography Benefits the Diagnosis and Follow-Up of Primary Central Nervous System Lymphoma with Intraocular Involvement

Abstract

Purpose To describe the characteristic manifestations of vitreoretinal lymphoma (VRL) with optical coherence tomography (OCT) and monitor their outcomes after treatmEnt. Patients and Methods Patients with primary central nervous system lymphoma (PCNSL) and intraocular involvement were assigned to the VRL group. OCT manifestations were analyzed and changes in abnormalities were recorded after intravitreal methotrexate injections. OCT manifestations of PCNSL patients without intraocular involvement were analyzed as well (non-VRL group). Results There were 48 eyes with high-quality OCT records in the VRL group, of which 19 had abnormal manifestations. The most frequent abnormality was outer retina (OR) fuzzy borders (14 of 19, 73.7%). Other abnormalities included: focal subretinal deposits (8 of 19, 42.1%), hyperreflective subretinal dots (2 of 19, 10.5%), pigment epithelium detachment (PED) (5 of 19, 26.3%), preretinal deposits (5 of 19, 26.3%), epiretinal membrane (3 of 19, 15.8%), cystoid macular edema (3 of 19, 15.8%), subretinal fluid (3 of 19, 15.8%), outer retina atrophy (2 of 19, 10.5%), unilateral optic papilledema (2 of 19, 10.5%), retinal thickening (1 of 19, 5.3%), and subretinal fibrosis (1 of 19, 5.3%). Nine eyes with retinal abnormalities were receiving regular intravitreal methotrexate. The retinal structure of seven eyes (only outer retina involved) returned to almost normal on OCT images. The remaining two eyes (with severe retinal vasculitis) showed little improvement after treatment. Conclusion OCT is helpful for the diagnosis of PCNSL with intraocular involvement and long-term follow-up of the disease. Summary Statement The characteristic manifestations of vitreoretinal lymphoma (VRL) with optical coherence tomography (OCT) were described and their outcomes after treatment were monitored. These findings suggested that OCT is helpful for the diagnosis of PCNSL with intraocular involvement and long-term follow-up of the disease.

Electroretinographic and Optical Coherence Tomographic Evaluations of Eyes with Vitreoretinal Lymphoma

“…Although several studies have been published that illustrated the OCT manifestations of primary VRLs or VRLs associated with CNS lymphomas [16][17][18][19][20]24,28,29,[32][33][34][35][36][37][38][39][40][41][42][43][44][45], most of the morphologic features were nonspecific [16,32,33]. Our cases also had some of the features found in other studies; however, these features were labelled differently by different authors(Supplemental Table S1) [16][17][18][19][20]24,28,29,[32][33][34][35][36][37][38][39][40][41][42][43][44][45]. It would be better if these features are named consistently ...…”

“…OCT is an important and helpful noninvasive method in diagnosing and managing retinal diseases including VRL. Although several studies have been published that illustrated the OCT manifestations of primary VRLs or VRLs associated with CNS lymphomas [ 16 , 17 , 18 , 19 , 20 , 24 , 28 , 29 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ], most of the morphologic features were nonspecific [ 16 , 32 , 33 ]. Our cases also had some of the features found in other studies; however, these features were labelled differently by different authors ( Supplemental Table S1 ) [ 16 , 17 , 18 , 19 , 20 , 24 , 28 , 29 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ].…”

“…Most of the abnormalities in our cases were nonspecific to lymphomas, including epiretinal membrane, focal intraretinal deposits, outer retinal fuzzy borders, epiretinal membrane, preretinal deposits, subretinal fluid, retinal thickening, and pigment epithelial detachments. The vertical hyperreflective lesions and hyperreflective subretinal dots were considered to be associated but not exclusively with lymphomas [ 17 , 19 , 20 ].…”

“…In Case 11, additional scans were performed that were centered on the temporal retina corresponding to the location of the creamy subretinal lesion. The OCT findings were evaluated according to that suggested by Deák et al [ 19 ] and Zhou et al [ 20 ].…”

“…Earlier optical coherence tomographic (OCT) studies of VRLs have shown that deposits were present above and below the RPE and infiltrations of highly reflective materials were present in the subretinal or inner retinal layers. OCT also showed a disruption of the ellipsoid zone (EZ) and clumps of cells in the vitreous cavity [ 16 , 17 , 18 , 19 , 20 , 21 ].…”