Hyper-reflective subretinal infiltrates visible on spectral domain optical coherence tomography (SD-OCT) could help diagnose primary vitreoretinal lymphoma (PVRL), researchers believe.
The finding could lead to earlier diagnosis of the rare disease; wrote Dr Robert J. Barry from the University of Birmingham, Birmingham, UK, and colleagues in the British Journal of Ophthalmology. “It is hoped that increased awareness of characteristic OCT findings in PVRL may improve patient outcomes in this life-limiting disease,” they said.
Most often an extranodal presentation of non-Hodgkin's lymphoma, PVRL can be hard to diagnose. It only turns up in 0.01% of all ocular diagnoses, so many clinicians do not even think of it. And the clinical findings are non-specific; it can look like some other form of posterior or intermediate uveitis.
Its characteristic features, large non-clumped vitreous cells and yellow subretinal deposits associated with retinal pigment epithelium detachments, can be found in a lot of other diseases.
Clinical clues include vitreous cells in sheets, visual acuity better than predicted from the amount of uveitic involvement and lack of cystoid macular oedema. However, confirmation usually requires vitreoretinal biopsy, and even then 30% to 40% of cytology specimens generate false negative results. Immunological analyses only work with highly differentiated tumours and may be limited by the development of a T-lymphocyte-driven inflammatory response to tumour antigens.