Spectral-domain optical coherence tomographic and fundus autofluorescence findings in eyes with primary intraocular lymphoma

Figures & data

Table 1 Clinical and imaging characteristics in three eyes with primary intraocular lymphoma

Case	Age (years) sex	Eye	PCNSL prior to PIOL	Result of vitreous biopsy				Imaging characteristics				VA after vitrectomy
				Cytological diagnosis	IL-10 (pg/mL)	IL-6 (pg/mL)	Ratio of IL-10/IL-6	Retinal finding	FA	FAF	OCT
1	57 male	Right	Yes	Class V	5,000	415	12.0	Diffuse subretinal infiltration	Leopard spot like pattern	N/A	Hyperreflective infiltration at the level of RPE, separation of Bruch membrane from the RPE, destruction of RPE and IS/OS, hyperreflective signals in inner retina	HM
2	57 male	Left	No	Class V	3,150	102	30.9	Small lesion mimicking drusen	Hyper, inverting fluorescence pattern of FAF	Granular pattern	Nodular hyperreflective infiltration at the level of RPE and above RPE, separation of Bruch membrane from the RPE, destruction of RPE and IS/OS, hyperreflective signals in inner retina	1.0
3	67 male	Left	Yes	Class III	1,820	66.5	27.4	Large whitish yellow spot	Hyper, inverting fluorescence pattern of FAF	Hypofluorescence and hyperfluorescence surrounding mass lesion	Hyperreflective infiltration at the level of RPE, separation of Bruch membrane from the RPE, destruction of IS/OS, hyperreflective lesions in the form of bands above RPE, hyperreflective signals in inner retina	0.15

Abbreviations: FA, fluorescein angiography; FAF, fundus autofluorescence; HM, hand motion; Hyper, hyperfluorescence; Hypo, hypofluorescence; IS/OS, inner segment/outer segment junction; IL, interleukin; N/A, not available; OCT, optical coherence tomography; PCNSL, primary central nervous system lymphoma; PIOL, primary intraocular lymphoma; VA, visual acuity.

Figure 1 Case 1. Fundus photographs, fluorescein angiograms, and spectral-domain optical coherence tomographic images of the right eye in a 57-year-old man with primary intraocular lymphoma after vitrectomy.

Notes: (A) Color fundus photograph shows diffuse retinal infiltration in the macula and retinal vasculitis in the temporal and nasal areas. (B) Late phase fluorescein angiogram showing hypofluorescent spots with a leopard spot pattern in the posterior fundus and staining of the arteries and an avascular area in the nasal region. (C) Spectral-domain optical coherence tomographic images. (Left) Nodular hyper-reflective infiltration at the level of the retinal pigment epithelium, separation of Bruch’s membrane from the retinal pigment epithelium, partial damage of the retinal pigment epithelium, disruption of the photoreceptor inner segment/outer segment junction, and hyper-reflective signals in the inner retina can be seen. (Right) A layered structure of the retina cannot be detected on the temporal side.

Figure 2 Case 2. Fundus images of the left eye in a 57-year-old man with primary intraocular lymphoma after vitrectomy.

Notes: (A) Color fundus photograph shows many small, yellowish lesions with distinct boundaries resembling drusen in the posterior fundus. (B) Cytological examination of vitrectomy specimen shows atypical lymphocytes with dyskaryosis and aberrant chromatin, stained using May-Grünwald-Giemsa. (C) Granular pattern of hypoautofluorescence and hyperautofluorescence is seen on fundus autofluorescence. (D) Late phase of fluorescein angiography shows hyperfluorescence of the disc and small spots with a reverse fluorescence pattern to the fundus autofluorescence pattern. (E) Spectral-domain optical coherence tomographic images. Nodular hyper-reflective infiltration at the level of retinal pigment epithelium and above the retinal pigment epithelium, a separation of Bruch’s membrane from the retinal pigment epithelium, partial destruction of the retinal pigment epithelium, disruption of the photoreceptor inner segment/outer segment junction line, and multiple hyper-reflective signals in the inner retina can be seen.

Figure 3 Case 3. Fundus images of the left eye in a 67-year-old man with primary intraocular lymphoma after vitrectomy.

Notes: (A) Fundus photograph showing many large whitish yellow spots with indistinct boundaries in the macular area. (B) Fundus autofluorescence image showing hypoautofluorescence and hyperautofluorescence surrounding a mass lesion with a honeycomb shape. (C) Late phase of fluorescein angiogram shows hyperfluorescence of the disc and fluorescence pattern which is the reverse of the fundus autofluorescence pattern. (D) Spectral-domain optical coherence tomographic image showing hyper-reflective infiltration at the level of the retinal pigment epithelium, separation of Bruch’s membrane from the retinal pigment epithelium, disruption of the photoreceptor inner segment/outer segment junction, hyper-reflective lesions in the form of bands above the retinal pigment epithelium, and hyper-reflective signals in the inner retina.