ObjectiveTo observe the color Doppler flow imaging (CDFI) features of vitreoretinal lymphoma (VRL). MethodsRetrospective case series. From January 2022 to December 2024, 71 eyes of 42 patients diagnosed with VRL at the Eye Center of Beijing Tongren Hospital were enrolled. Among them, 17 were male and 25 female; 29 had bilateral and 13 unilateral involvement. Age ranged 17-78 years (median 59 years). Eleven cases had histopathologic confirmation and 31 were clinically diagnosed. All patients underwent CDFI and optical coherence tomography (OCT). CDFI findings were analyzed, noting the presence or absence of vitreous opacities (centrifugal distribution), posterior vitreous detachment (PVD), retinal detachment, and retinal elevated lesions. With Doppler overlay, blood flow within retinal lesions was assessed. The χ2 test was used to compare the detection rates of retinal lesions by CDFI and OCT, while Cohen’s Kappa assessed agreement in identifying the depth of lymphoma cell infiltration. ResultsAmong 71 eyes, vitreous opacity occurred in 66 eyes (93.0%, 66/71), of which 40 eyes (60.6%, 40/66) showed centrifugal opacity. 58 eyes (81.7%, 58/71) had posterior vitreous detachment. Retinal detachment occurred in 7 eyes (9.9%, 7/71). Retinal occupying lesions occurred in 23 eyes (32.4%, 23/61), of which 15 eyes (65.2%, 15/23) showed blood flow signals on the surface of the lesions but no blood flow signals inside the lesions by CDFI, and OCT showed that tumor cells gathered under the retinal pigment epithelium. CDFI showed blood flow signals inside the lesions in 8 eyes (34.8%, 8/23), and OCT showed that tumor cells gathered between retinal neuroepithelial layers. The lesion detection rate of OCT (69.6%, 16/23) was significantly lower than that of CDFI (100.0%, 23/23) (χ2= 6.066, P=0.014). OCT and CDFI showed perfect agreement in determining the depth of tumor cell infiltration (Kappa=1.0).ConclusionsThe ultrasonographic manifestations of VRL include vitreous opacity, PVD, and some retinal occupying lesions. Vitreous opacity often presents a characteristic centrifugal distribution. By observing whether there is blood flow signal in retinopathy using Doppler, the level of lymphoma cell infiltration can be suggested.
In recent years, the complexity of intraocular lymphoma has been gradually recognized by ophthalmologists. Although primary vitreoretinal lymphoma is the dominant type of intraocular lymphoma, ophthalmologists should be aware that it is not unique and avoid overgeneralizing specific clinical features to all intraocular lymphoma types. Intraocular lymphoma can be divided into vitreoretinal, uveal (choroid, iris, ciliary body) lymphoma according to the anatomic affected parts. According to pathological cell types, it can be divided into B cells, mantle cells, T cells and natural killer T cells. At the same time, depending on the presence or absence of extra-ocular tissue involvement, it can also be subdivided into isolated intraocular, oculo-central nervous system, oculo-system, and oculo-central nervous system lymphomas. Vitreoretinal lymphoma tends to occur in the elderly with clinical manifestations similar to uveitis and white spot syndrome and limited response to glucocorticoid therapy. The characteristic fundus manifestations include vitreous gauzy or "auroral" opacity and yellowish-white subretinal mass. Optical coherence tomography plays a key role in diagnosis and can reveal specific changes such as vertical strong reflex and intraretinal strong reflex infiltration. It is worth noting that vitreous and retinal involvement may vary, which has guiding significance for the selection of treatment strategies. In contrast, uveal lymphoma has unique clinical and pathological features, such as the chronic course of choroidal mucosa-associated lymphoid tissue (MALT) lymphoma and the equal distribution of T cells and B cells in iris lymphoma. In diagnosis, choroidal lymphoma often requires histopathological examination, and radiotherapy is the first choice for MALT lymphoma. T-cell lymphoma is similar to B-cell lymphoma in ocular fundus appearance, but diagnosis is more difficult and depends on cytopathology and T-cell receptor gene rearrangement. Comprehensive systematic screening is essential for patients with intraocular lymphoma to identify the primary site. Ocular lesions in patients with systemic lymphoma require differential diagnosis, including tumor invasion, secondary infection, and inflammatory lesions. As the incidence of lymphoma increases, ophthalmologists should constantly update their understanding of intraocular lymphoma to provide accurate diagnosis and treatment.
ObjectiveTo observe the clinical characteristics of patients with systemic intraocular lymphoma (IOL). MethodsA retrospective clinical study. From January 2016 to December 2024, 14 patients (23 eyes) who were diagnosed with system-IOL at Beijing Tongren Hospital, Beijing Intech Aier Eye Hospital, and Beijing Aier Eye Hospital were included in the study. Data on medical history, pathological subtype, ocular manifestations, treatment, and clinical outcomes were collected. The clinical features, therapeutic approaches, and prognosis were retrospectively analysed. The 1-year survival rate after ocular involvement was estimated using the Kaplan-Meier method. ResultsAmong the 14 patients, 5 were male and 9 were female, with a mean age of (57±9) years. Nine patients, involving 14 eyes, had a confirmed history of systemic lymphoma before the onset of IOL, whereas 5 patients, involving 9 eyes, initially presented with ocular symptoms and were subsequently found to have concomitant systemic lymphoma. Systemic lesions involved the lymph nodes, breast, adrenal gland, testis, spine, nasal region, gingiva, chest wall, and submandibular mass in 4, 2, 2, 1, 1, 1, 1, 1, and 1 patient, respectively. Diffuse large B-cell lymphoma (DLBCL) and natural killer/T-cell lymphoma were identified in 11 and 3 patients, respectively. One patient had composite lymphoma, with ocular DLBCL and systemic natural killer/T-cell lymphoma; the pathological subtype of systemic and ocular lymphoma was concordant in 13 patients. The interval from systemic lymphoma to ocular involvement was 4.2 (1, 14) years. Among the 23 eyes, keratic precipitates were observed in 13 eyes (56.5%, 13/23), varying degrees of anterior chamber inflammation in 11 eyes (47.8%, 11/23), and vitreous opacity in all 23 eyes (100.0%, 23/23). Vitreous infiltration was the predominant manifestation in 4 eyes (17.4%, 4/23), whereas retinal infiltration was observed in 19 eyes (82.6%, 19/23). Systemic treatment included systemic chemotherapy, local radiotherapy, chimeric antigen receptor T-cell therapy, and autologous stem cell transplantation. Intravitreal chemotherapy was administered to 8 patients involving 14 eyes. After treatment, regression of ocular lesions and improvement in visual acuity were observed in 11 eyes. Visual acuity decreased in 2 eyes, including 1 eye with optic nerve infiltration and 1 eye in a patient with newly detected systemic lesions. Among the 14 patients, 3 were lost to follow-up and 2 died. The 1-year survival rate after ocular involvement was 84.6%. ConclusionsDLBCL is the most common pathological subtype of systemic-IOL, followed by T-cell lymphoma. Ocular involvement in systemic-IOL may also present as a vitreoretinal pattern, characterised by vitreous opacity and retinal infiltration, with a relatively high proportion of anterior segment inflammation. Intravitreal chemotherapy may effectively induce regression of intraocular lesions and improve visual acuity. In cases with suboptimal treatment response, newly developed ocular lesions and systemic disease progression should be carefully considered.
