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DIFFERENTIAL DIAGNOSIS FOR VITREORETINAL LYMPHOMA WITH VITREORETINAL FINDINGS, IMMUNOGLOBULIN CLONALITY TESTS, AND INTERLEUKIN LEVELS

Lee, Junwon, MD, PhD*; Kim, Seung WOO, MD; Kim, Hyesun, MD; Lee, Christopher SEUNGKYU, MD, PhD§; Kim, Min, MD, PhD§; Lee, Sung CHUL, MD, PhD*

doi: 10.1097/IAE.0000000000002127
Original Study
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Purpose: To analyze vitreoretinal findings, immunoglobulin clonality tests, and interleukin (IL) levels for diagnosing vitreoretinal lymphoma (VRL).

Methods: Forty-three patients who underwent diagnostic vitrectomy for suspected VRL were retrospectively reviewed. Of those patients finally diagnosed with VRL and nonlymphoma, ophthalmic evaluation and cytology results, IL-6 and IL-10 levels, and immunoglobulin heavy chain and immunoglobulin kappa light chain clonality assays were compared.

Results: Sub-retinal pigment epithelium infiltration and veil-pattern vitreous opacity were specific vitreoretinal findings in patients with VRL. The area under the receiver operating characteristic curve of the IL-10-to-IL-6 ratio and of IL-10 levels was 0.972 and 0.931, respectively. A combined immunoglobulin heavy chain and immunoglobulin kappa light chain assay showed increased sensitivity, whereas the determined specificity of immunoglobulin kappa light chain, at 94.12%, was much higher than the 78.95% of immunoglobulin heavy chain. Patients with VRL with atypically elevated IL-6 levels showed extensive and severe sub-retinal pigment epithelium infiltration.

Conclusion: Newly screened immunoglobulin kappa light chain clonality assays may be useful to distinguish VRL from uveitis with high specificity. When sub-retinal pigment epithelium or retinal infiltration is severe and extensive, the IL-10-to-IL-6 ratio may not be typical and should be carefully interpreted.

Sub-retinal pigment epithelium infiltration and veil-pattern vitreous opacity are specific vitreoretinal findings in vitreoretinal lymphoma patients. Newly applied immunoglobulin kappa chain clonality assay shows much higher specificity than heavy chain clonality assay. Vitreoretinal lymphoma patients with severe sub-retinal pigment epithelium infiltration show atypically elevated interleukin-6 levels.

*Department of Ophthalmology, Eye and ENT Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea;

Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea;

Siloam Eye Hospital, Seoul, South Korea; and

§Department of Ophthalmology, Institute of Human Barrier Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.

Reprint requests: Sung C. Lee, MD, PhD, Department of Ophthalmology, Eye and ENT Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea,; e-mail: sunglee@yuhs.ac

None of the authors has any financial/conflicting interests to disclose.

© 2019 by Ophthalmic Communications Society, Inc.