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    SD-OCT may help diagnose primary vitreoretinal lymphoma


    Hyper-reflective lesion findings

    SD-OCT has appeared successful as a non-invasive aid to diagnosis in previous very small case series. To further this research, Dr Barry and colleagues analysed records of 32 eyes of 22 patients from Moorfields Eye Hospital in London, UK, whose PVRL was later confirmed by biopsy.

    Dr Barry and another masked observer assessed anonymised OCT images, compiling a list of positive findings. They used the earliest-available images, created prior to any lymphoma-specific treatment. They discussed these findings with the four other co-authors of the study to create a final list of features associated with PVRL.

    They observed hyper-reflective lesions across multiple retinal layers. In 17 eyes, they found these lesions in the subretinal space, either in the form of discrete nodules or a confluent band.

    These lesions were accompanied by disruption of the photoreceptor inner segment/outer segment junction. They found hyper-reflective infiltration in the inner layers of the retina in six eyes and irregularity of the retinal pigment epithelium in five eyes.

    In five eyes, there were hyper-reflective foci in the posterior vitreous. In three, there were subretinal pigment epithelial deposits associated with steep elevation of the retinal pigment epithelium. There was cystoid macular oedema in five eyes.

    The sub-retinal pigment epithelium infiltrates observed in these patients differed from choroidal infiltrates seen in choroidal lymphoma, the researchers said. In PVRL, the infiltration is localised between the retinal pigment epithelium and Bruch’s membrane. The choroid appears separately to the retinal pigment epithelium and immediately deep to Bruch’s membrane. The infiltration shows a homogenous, hyper-reflective quality.

    By contrast, in choroidal lymphoma, the infiltration is usually of a mucosa-associated lymphoid tissue seen deep to Bruch’s membrane, without separation of the retinal pigment epithelium.

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