Multimodal Imaging of Spontaneously Shifting Primary Vitreoretinal Lymphoma

To correlate spectral domain optical coherence tomography (SD-OCT) and photographic imaging before and after spontaneous regression of primary vitreoretinal lymphoma (PVRL) lesions.

We report the case of a 60-year-old female.

The patient presented with bilateral creamy deposits under the retina and retinal pigment epithelium (RPE), and lesions were visible along Bruch's membrane with SD-OCT and suspicious for PVRL. Systemic workup revealed nonspecific areas of enhancement on neuroimaging. The patient was largely asymptomatic and the decision was made to observe her. Three months later, a new lesion pattern had developed. The color fundus photographs and SD-OCT demonstrated spontaneous regression of the largest sub-RPE lesion, leaving areas of RPE atrophy, while a new larger sub-RPE lesion had formed in the other eye. Vitreous biopsy showed lymphocytes and no malignant cells, while sub-RPE biopsy of the newly formed lesion revealed highly atypical cells positive for CD19 and CD20.

Multimodal imaging documents that PVRL lesion regression and early RPE changes can develop within a 3-month period. Immune control is an important factor in lesion regression in the eye.