Optical coherence tomography features and visual prognosis in vitreoretinal lymphoma: a structured phenotyping study

Area of Science:

• Ophthalmology
• Oncology
• Medical Imaging

Background:

• Vitreoretinal lymphoma (VRL) is a rare intraocular malignancy.
• Accurate diagnosis and monitoring of VRL are crucial for visual prognosis.
• Optical coherence tomography (OCT) is a key imaging modality in ophthalmology.

Purpose of the Study:

• To characterize baseline optical coherence tomography (OCT) features of vitreoretinal lymphoma (VRL).
• To identify OCT features associated with visual prognosis in VRL.
• To describe longitudinal OCT changes following intravitreal methotrexate (IVT-MTX) treatment for VRL.

Main Methods:

• Retrospective analysis of spectral-domain OCT (SD-OCT) features in biopsy-proven VRL cases.
• Classification of OCT findings into sub-RPE, subretinal, and intraretinal deposits, alongside EZ disruption and EZ-RPE attenuation.
• Statistical analysis using generalized estimating equations (GEE) and a LASSO model to assess visual outcomes and predict vision loss, with longitudinal analysis of IVT-MTX treatment response.

Main Results:

• Sub-retinal pigment epithelium (sub-RPE) deposits were the most frequent OCT finding (92.1%).
• Baseline best-corrected visual acuity (BCVA) and ellipsoid zone (EZ) disruption were significantly associated with worse visual outcomes (p=0.009 and p=0.026, respectively).
• EZ disruption and EZ-RPE attenuation showed high predictive value (AUC=0.929) for significant vision loss. Longitudinal OCT revealed rapid resolution of vitreous cells, slow regression of sub-RPE/subretinal deposits, and persistent EZ disruption after IVT-MTX treatment.

Conclusions:

• Sub-RPE deposits are the most common OCT finding in VRL.
• EZ disruption and EZ-RPE attenuation are indicators of poor visual prognosis in VRL.
• OCT demonstrates differential treatment responses in VRL, highlighting its utility for monitoring IVT-MTX therapy.