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Original Investigation
November 29, 2018

Vertical Hyperreflective Lesions on Optical Coherence Tomography in Vitreoretinal Lymphoma

Author Affiliations
  • 1Feinberg School of Medicine, Department of Ophthalmology, Northwestern University, Chicago, Illinois
  • 2Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
JAMA Ophthalmol. Published online November 29, 2018. doi:10.1001/jamaophthalmol.2018.5835
Key Points

Question  Are there optical coherence tomography (OCT) features that might suggest the diagnosis of vitreoretinal lymphoma?

Findings  This case series study found that microscopic lesions were visible as hyperreflective columns between the retinal nerve fiber layer and the retinal pigment epithelium on OCT in 5 of 7 patients (7 of 12 eyes) with vitreoretinal lymphoma. Vertical hyperreflective lesions were often seen on subretinal pigment epithelial deposits and in many cases preceded the appearance of such lesions.

Meaning  Vertical hyperreflective lesions on OCT may suggest the diagnosis of vitreoretinal lymphoma and provide clues as to the pathogenesis of this disease.

Abstract

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 Department of Ophthalmology at Northwestern University between July 2014 and January 2016.

Main Outcomes and Measures  Optical coherence tomography findings in vitreoretinal lymphoma.

Results  We identified 7 patients (4 women [57.1%]; mean [range] age, 62.4 [45-75] years; 12 eyes) with intraocular lymphoma involving the retina (5 patients [71.4%] with primary vitreoretinal or central nervous system lymphoma with ocular involvement, 1 patient [14.3%] with testicular lymphoma with secondary central nervous system lymphoma and vitreoretinal lymphoma, and 1 patient [14.3%] with secondary vitreoretinal lymphoma). We identified vertical hyperreflective lesions that showed moderate or high reflectivity and affected all layers of the neuroretina in 5 patients (7 of 12 eyes [58.3%]). These often preceded the development of subretinal pigment epithelial deposits and were often localized around second-order and third-order retinal vessels. In most cases, they resolved with minimal or no scarring after the initiation of chemotherapy.

Conclusions and Relevance  Vertical hyperreflective lesions are a common physical finding on OCT in eyes with vitreoretinal lymphoma.

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