Multimodal imaging characteristics in eyes with vitreoretinal lymphoma treated with intravitreal rituximab

• Published in: International ophthalmology 2021-08, Vol.41 (8), p.2711-2722
• Main Authors: Rishi, Pukhraj, Maitra, Puja, Das, Kalpita, Rishi, Ekta, Manchegowda, Pradeep T.
• Format: Article
• Language: English
• Subjects: Biomarkers; Biopsy; Edema; Epithelium; Eye; Eye (anatomy); Fluorescein Angiography; Health services; Hemorrhage; Humans; Immunotherapy; Intraocular Lymphoma - diagnosis; Intraocular Lymphoma - drug therapy; Intravitreal Injections; Lesions; Lymphoma; Medical imaging; Medicine; Medicine & Public Health; Monoclonal antibodies; Multimodal Imaging; Neoplasm Recurrence, Local; Ophthalmology; Original Paper; Patients; Photography; Pigmentation; Remission; Retina; Retinal Neoplasms - diagnosis; Retinal Neoplasms - drug therapy; Retinal pigment epithelium; Retrospective Studies; Rituximab; Skin pigmentation; Targeted cancer therapy; Thickness; Tomography, Optical Coherence; Visual Acuity; Vitreous Body
• ISSN: 0165-5701; 1573-2630
• DOI: 10.1007/s10792-021-01828-8

Purpose To characterize the imaging features in eyes with vitreoretinal lymphoma (VRL) using ultra-widefield fundus photography (UWF-FP), swept-source optical coherence tomography (SSOCT) and fundus autofluorescence (FAF) that are correlated to ongoing treatment with intravitreal Rituximab(IVR). Methods Retrospective observational imaging-based study of 15 treatment-naive eyes with VRL treated with IVR. All patients with primary VRL underwent vitreous biopsy using 23/25G microincision vitrectomy system for confirmation of diagnosis. All eyes received monthly IVR (1 mg/0.1 mL) injections till disease remission. Baseline clinical characteristics, treatment details, outcomes, and sequential imaging features on UWF-FP, FAF, and SSOCT were analyzed. Outcome measures Baseline features and changes in UWF-FP, FAF patterns, and SSOCT features in response to treatment Results Clinically, patients presented with sub-RPE deposits ( n  = 15), superficial retinal hemorrhages ( n  = 2), ‘giant’ RPE (retinal pigment epithelium) holes ( n  = 2), and anterior segment reaction ( n  = 1). Eyes were treated with mean 5.7 IVR injections (median: 5; range 1–13) over a mean 7.2 ± 4.9 months. During the course of treatment, two eyes developed superficial retinal hemorrhages with spontaneous resolution, 2 eyes developed CME, and 4 eyes developed characteristic ‘leopard skin’ pigmentation. Hyper-autofluorescence corresponding to areas of active lesions decreased with each treatment cycle and was finally replaced by hypo-autofluorescence. Serial OCTs showed regression of sub-RPE/subretinal deposits ( n  = 15), ellipsoid zone disruption ( n  = 9), and its resolution with treatment ( n  = 3), epiretinal membrane (ERM; n  = 6), choroidal hyperreflective foci (HRF; n  = 4), disorganization of retinal inner layers (DRIL; n  = 3), RPE-rip ( n  = 2), cystoid macular edema (CME; n  = 2), and hyperreflective lesions in the choroid ( n  = 1). Complete resolution was observed in all eyes with extensive hypo-AF. The central foveal thickness decreased from 237 ± 113 μ to 182 ± 114 μ ( p  = 0.1) and subfoveal choroidal thickness decreased from 258 ± 66 μ to 220 ± 64 μ ( p  = 0.12) at final follow-up. The mean baseline BCVA was logMAR 0.9 ± 0.9 that deteriorated to mean logMAR 1 ± 1 final visit ( p  = 0.7). The mean recurrence-free follow-up was 5.9 ± 5.1 months Conclusion Multimodal imaging provides novel insights into features of VRL, a better understanding of regression patterns, and prognostica