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Published on: March 26, 2020
Retinal Pigment Epithelium Disruption Lesions on Optical Coherence Tomography in Patients With Vitreoretinal Lymphoma
Wenwen Chen1, Tingting Jiang1, Junxiang Gu1
1From the Eye Institute and Department of Ophthalmology (W.C., T.J., J.G., S.L., X.Z., Q.C.), Eye & ENT Hospital, Fudan University, Shanghai, China; Key Laboratory of Myopia and Related Eye Diseases, NHC; Key Laboratory of Myopia and Related Eye Diseases (W.C., T.J., J.G., S.L., X.Z., Q.C.), Chinese Academy of Medical Sciences, Fudan University, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration (W.C., T.J., J.G., S.L., X.Z., Q.C.), Shanghai, China.
Purpose:
To describe the imaging characteristics and clinical relevance of retinal pigment epithelium (RPE) disruption lesions observed on optical coherence tomography (OCT) of patients with biopsy-proven vitreoretinal lymphoma (VRL).
Design:
Retrospective interventional case series.
Subjects:
Patients diagnosed with VRL at the Eye and ENT Hospital of Fudan University between July 2017 and June 2024.
Methods:
The clinical characteristics, outcomes, and multimodal retinal imaging findings of the eligible VRL patients were collected and studied. RPE disruption lesions were defined as full-thickness RPE discontinuities on OCT and were categorized as major (>300 µm) or minor (<300 µm) based on OCT-measured width.
Main Outcome Measures:
The associated features of RPE disruption lesions on OCT.
Results:
Totally 158 eyes of 81 patients were included in the analysis. RPE disruption lesions were detected in 51 of 65 affected eyes of 36 patients. Most of the lesions (47/51 eyes) were detected at initial presentation or disease onset. On OCT scans, 17 eyes had major RPE disruption lesions, and 34 eyes only had minor disruption lesions. The RPE disruption lesions were colocalized with intraretinal or subretinal infiltration. Among the eyes with full-thickness intraretinal infiltration, 14 eyes (14/24) exhibited perivascular infiltration. Major RPE disruption lesions showed a stronger association with subretinal infiltration (P = .041), while minor disruptions demonstrated preferential correlation with intraretinal infiltration (P = .036). On fundus autofluorescence, the RPE disruption lesions sometimes manifest as characteristic hypo-autofluorescent spots accompanied by hyper-autofluorescent rings. Eyes with minor RPE disruption lesions showed a better visual outcome compared to those with major lesions (P = .013), with statistically significant improvement from baseline after treatment (P = .00017). The median recovery time for the RPE disruption lesions was 2.0 months (IQR 1.5-4.0 months). The accompanied retinal infiltration vanished with the recovery of RPE disruption lesions.
Conclusions:
RPE disruption lesions represent frequently occurring yet underrecognized OCT findings in VRL. Notably, the lesions provide diagnostic clues for VRL identification and may reveal a potential migration pathway for lymphocytic infiltrates between sub-RPE and subretinal/intraretinal spaces.
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