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Lavine, Jeremy A., MD, PhD; Singh, Arun D., MD; Sharma, Sumit, MD; Baynes, Kimberly, BSN, RN; Lowder, Careen Y., MD, PhD; Srivastava, Sunil K., MD

doi: 10.1097/IAE.0000000000002260
Original Study: PDF Only

Purpose: To determine the features of primary vitreoretinal lymphoma on multimodal ultra-widefield imaging and correlate these findings to clinical outcomes.

Methods: We report a retrospective, observational case series of 43 eyes of 23 patients with biopsy-proven B-cell primary vitreoretinal lymphoma. Fundus photography, fluorescein angiography (FA), optical coherence tomography, fundus autofluorescence, and indocyanine green angiography images were reviewed. Medical records were assessed for the central nervous system involvement and visual acuity outcomes at 6 and 12 months after presentation.

Results: Common fundus photography findings were sub–retinal pigment epithelium lesions and vitritis alone. Common ultra-widefield FA findings were vascular leakage and scleral staining. Retinal optical coherence tomography features overlying sub–retinal pigment epithelium lesions or within the macula predicted fluorescence patterns. The presence of retinal fluid or disorganization associated with hyperfluorescence and late leakage. Normal retinal structures associated with hypofluorescence of sub–retinal pigment epithelium lesions or macular leopard spotting on FA and fundus autofluorescence. Peripheral abnormalities noted on ultra-widefield fundus photography, FA, and indocyanine green angiography were more frequent than posterior pole abnormalities. No imaging characteristics predicted time to the central nervous system progression.

Conclusion: Ultra-widefield imaging was more informative than posterior pole imaging in fundus photography, FA, and indocyanine green angiography. Common findings on multimodal ultra-widefield imaging may lead to early diagnostic vitrectomy and may reduce the delay in primary vitreoretinal lymphoma diagnosis.

Ultra-widefield multimodal imaging of primary vitreoretinal lymphoma demonstrates vitritis with or without sub–retinal pigment epithelium lesions on fundus photography, and vascular leakage and scleral staining on fluorescein angiography. Retinal fluid or disorganization on optical coherence tomography predicts whether sub–retinal pigment epithelium lesions will display fluorescein angiography hyperfluorescence and leakage. Ultra-widefield multimodal imaging can reduce the delay in diagnosis of primary vitreoretinal lymphoma.

Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio.

Reprint requests: Sunil K. Srivastava, MD, Cole Eye Institute, 9500 Euclid Avenue i-32, Cleveland, OH 44195; e-mail:

S. K. Srivastava receives research support from Allergan (Dublin, Ireland), Santen (Osaka, Japan), and Psivida (Watertown, MA).

A. D. Singh is a consultant and receives an honorarium from Iconic Therapeutics (San Francisco, CA), Castle Biosciences (Phoenix, AZ), and Isoaid (Port Richey, FL). A. D. Singh is on the advisory board and has stock options with Aura Biosciences (Cambridge, MA). S. Sharma is a consultant for Allergan (Dublin, Ireland). C. Y. Lowder is on the data and safety monitoring committee for Allergan (Dublin, Ireland) and receives a consulting fee. S. K. Srivastava is a consultant for Optos (Marlborough, MA), Zeiss (Oberkochen, Germany), Santen (Osaka, Japan), Clearside (Alpharetta, GA), Gilead (Foster City, CA), Regeneron (Tarrytown, NY), and Psivida (Watertown, MA). The remaining authors have no conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.