Purpose

To describe multimodal imaging findings in primary vitreoretinal lymphoma (PVRL).

Methods

The medical records and imaging findings of 4 patients (4 eyes) diagnosed with PVRL were retrospectively reviewed. Detailed ophthalmic examination, fundus photography, fundus autofluorescence (FAF), fluorescein angiography (FA), optical coherence tomography (OCT) and OCT angiography (OCTA) were analyzed in all patients. All patients underwent vitreous biopsy for diagnosis confirmation. Brain magnetic resonance imaging (MRI) was performed in all cases.

Results

There were 2 women and 2 male patients with a mean age of 68.75 years. Visual blurring was the presenting symptom in all patients (100%). Clinical findings at presentation included vitritis in 4 eyes (100%), vitreous clumps in 2 eyes (50%), subretinal deposits in 3 eyes (75%) and exudative retinal detachment in one eye (25%). FAF showed granular hyperautofluorescence and hypoautofluorescence lesions in 3 eyes (75%) and blockage by mass lesion was seen in 1 eye. The most common pattern on FA was hypofluorescent lesions with a “leopard spot” appearance (75%). OCT revealed hyperreflective sub retinal lesions between RPE and Bruch’s membrane with an undulating shape (seasick sign) in 3 eyes (75%) and epiretinal membrane in one eye. OCTA showed areas of decreased signal on choriocapillaris slab in 2 eyes (50%). MRI of the globes and brain showed no abnormality in all cases. Vitreous cytology revealed atypical mononuclear cells consisting with the diagnosis of PVRL in all cases. The patients were referred to oncology unit.

Conclusions

The diagnosis of PVRL is challenging. Multimodal imaging provides novel insights into features of PVRL.