Vitreoretinal Lymphoma with Intraretinal Infiltration, Simulating Retinal Necrosis

Area of Science:

• Ophthalmology
• Oncology
• Retinal Diseases

Background:

• Vitreoretinal lymphoma (VRL) is a rare intraocular malignancy.
• Understanding its diverse clinical presentations is crucial for timely diagnosis and management.
• A pseudonecrotic variant of VRL, characterized by intraretinal infiltration, has been described.

Purpose of the Study:

• To delineate the clinical features and visual outcomes of VRL presenting with intraretinal infiltration, specifically a pseudonecrotic variant.
• To compare the presentation and prognosis of this variant against nonnecrotic VRL.

Main Methods:

• Retrospective analysis of biopsy-proven VRL cases from a single center (August 2016 - April 2022).
• Categorization of eyes into pseudonecrotic (with pseudonecrotic retinal lesions) and nonnecrotic groups.
• Comparative analysis of clinical features, best-corrected visual acuity (BCVA), ocular manifestations, and survival outcomes.

Main Results:

• Of 67 eyes from 40 patients, 24 eyes (35.8%) exhibited the pseudonecrotic variant.
• Pseudonecrotic VRL eyes presented with significantly worse BCVA (2.4 vs. 0.5 logMAR) and more severe ocular manifestations, including optic disc swelling, vasculitis, hemorrhage, and retinal detachment (all P < 0.0001).
• Worse BCVA persisted at 6 months and final follow-up in the pseudonecrotic group (2.4 vs. 0.3 logMAR). Initial BCVA, anterior chamber cell, and retinal detachment were associated with poor visual outcomes.

Conclusions:

• Vitreoretinal lymphoma can present as a pseudonecrotic retinopathy.
• This variant is associated with more severe clinical presentations and significantly worse visual prognoses.
• Early detection and management strategies may be critical for improving outcomes in these patients.