Vertical Hyperreflective Lesions on Optical Coherence Tomography in Vitreoretinal Lymphoma

Abstract

itreoretinal lymphomas (VRL) are rare diseases. They comprise about 1% to 3% of intraocular tumors and the incidence varies between 0.02 to 0.05 of 100 000 people in the North American population. 1 In almost 90% of cases, VRLs are diffuse large B cell lymphomas (DLBCLs) and are considered to be a subtype of the primary DLBCLs of the central nervous system (CNS). Sixteen percent to 34% of patients with VRL have CNS involvement at the time of diagnosis and 35% to 90% will develop CNS lymphoma during the course of their disease. Conversely, 15% to 25% of patients with CNS lymphoma develop VRL. 2,3 Optical coherence tomography (OCT) is an important noninvasive diagnostic tool in diagnosing and managing retinal diseases. In VRL, most of the morphologic features that are seen on OCT are nonspecific. 4-6 The aim of this study was to describe an OCT feature in patients with confirmed VRL. Methods We conducted a retrospective medical record review of patients who received a diagnosis of VRL at the Department of Ophthalmology at Northwestern University. The protocol was approved by the institutional ethics committee, who waived patient consent, and adhered to the Declaration of Helsinki. Patients who had a diagnosis of intraocular lymphoma who were seen by 2 senior attending physicians (D.A.G. and L.M.J.) between July 2014 and January 2018 were identified using a search of electronic medical records. Patient records and all imaging modalities that were carried out at the initial visit and subsequent visits were collected and reviewed for completeness and consistency. The exclusion criteria were an uncertain diagnosis and inadequate OCT image quality. Optical co-IMPORTANCE Vitreoretinal lymphoma is a diagnostic challenge and the pathophysiology is still unclear. OBJECTIVE To describe an imaging finding seen on optical coherence tomography (OCT) of patients with vitreoretinal lymphoma. DESIGN, SETTING, AND PARTICIPANTS This case series study was a retrospective medical record review of patients who received a diagnosis of vitreoretinal lymphoma at the

Secondary vitreoretinal lymphoma with spontaneous regression

“… 4 Both presentations in our patient had clinical features similar to PVRL. The vertical hyper-reflective lesion (VHRL) evident on OCT during the second recurrence has been described by Deák et al 14 In their series, VHRLs were identified in 7 of 12 eyes with vitreoretinal lymphoma and postulated to be due to lymphomatous retinal infiltration arising from retinal vessels.…”

Clinical sign and symptom of primary vitreoretinal lymphoma short-time after retinal reattachment surgery: a case report

“…The first sign was two hyper-reflective lines with vertical orientation from outer nuclear layer and EZ in the foveola. These vertical lines may be a precursor to sub-RPE infiltrations, and some may be a relation between retinal vessels involvement and sub-RPE deposits, according to some theories [5] Deak et al hypothesized that these vertical lines may represent early microinfiltrates originating from retinal capillaries, which cannot be recognized in fundus examination. They observed these lines in more than half of their cases.…”

Gliotic opaque posterior hyaloid membrane separation: report of two cases

“…These findings would again be distinctly different from the ground-glass-sheet opacity showing much more diffuseness and uniformity strictly confined to the PHM surface. Based on the combination of several other negative findings, such as intravitreal atypical lymphocytes on histology, ocular relapse often with systemic involvements [ 8 ], and abnormal deposits at multiple retinal layers on OCT [ 9 , 10 ], vitreoretinal lymphoma was excluded from the differential diagnosis. We could not detect any inflammatory cells in the anterior chamber or the vitreous cavity during follow-up, thus denying the presence of uveitis in our cases.…”