背景:玻璃体视网膜淋巴瘤(VRL)是一种罕见的眼内恶性肿瘤,由于其类似葡萄膜炎的非特异性临床表现,对诊断提出了挑战。使用谱域光学相干断层扫描(SD-OCT)已成为表征VRL的有价值的成像工具。因此,我们试图确定VRL与uveitides相比的具体OCT特征.
方法:回顾性图表回顾了2010年1月1日至2022年12月31日在梅奥诊所就诊的患者。对活检证实为VRL的患者的医疗记录和初次就诊时的SD-OCT图像进行审查,中间葡萄膜炎,或活检证实结节病后葡萄膜炎。包括患有VRL或类似葡萄膜炎的患者,包括中间葡萄膜炎或结节病后葡萄膜炎。
结果:VRL组56例95眼,葡萄膜炎组45例86眼,其中15例(33.3%)被诊断为中度葡萄膜炎,30例(66.7%)被诊断为结节病脉络膜视网膜炎。在VRL患者的初始表现中,SD-OCT特征更常见(与葡萄膜炎)包括视网膜前沉积物(31.6%与9.3%,p=0.002),卷内浸润(34%vs.3.5%,p<0.001),内部视网膜过度反射斑点(15.8%vs.0%,p<0.001),外视网膜萎缩(22.1%vs.2.3%,p<0.001),视网膜下局灶性沉积物(21.1%vs.4.7%,p=0.001),视网膜色素上皮(RPE)变化(49.5%vs.3.5%,p<0.001),和次级RPE存款(34.7%与0%,p<0.001)。葡萄膜炎中更常见的特征包括视网膜前膜(ERM)(82.6%vs.44.2%,p<0.001),黄斑中心增厚(95.3%vs.51.6%,p<0.001),黄斑囊样水肿(36%vs.11.7%,p<0.001),视网膜下液(16.3%vs6.4%,p=0.04),和凹下液体(16.3%vs.3.2%,p=0.003)。控制年龄和性别的多因素回归分析显示没有ERM(OR0.14[0.04,0.41],p<0.001)和没有中央黄斑增厚(OR0.03[0,0.15],p=0.02)与葡萄膜炎相反,与VRL相关。
结论:OCT具有最能预测VRL的功能(与葡萄膜炎)包括没有ERM和中央黄斑增厚。
BACKGROUND: Vitreoretinal lymphoma (VRL) is a rare intraocular malignancy that poses a diagnostic challenge due to the non-specific clinical presentation that resembles uveitis. The use of spectral domain optical coherence tomography (SD-OCT) has emerged as a valuable imaging tool to characterize VRL. Therefore, we sought to determine the specific OCT features in VRL compared to the uveitides.
METHODS: Retrospective chart review of patients who were seen at Mayo Clinic from January 1, 2010 through December 31, 2022. The medical records and SD-OCT images at time of initial presentation were reviewed in patients with biopsy-proven VRL, intermediate uveitis, or biopsy-confirmed sarcoid posterior uveitis. Patients with VRL or similar uveitides including intermediate uveitis or sarcoid posterior uveitis were included.
RESULTS: There were 95 eyes of 56 patients in the VRL group and 86 eyes of 45 patients in the uveitis group, of whom 15 (33.3%) were diagnosed with intermediate uveitis and 30 (66.7%) with sarcoid chorioretinitis. The SD-OCT features more commonly seen at initial presentation in VRL patients (vs. uveitis) included preretinal deposits (31.6% vs. 9.3%, p = 0.002), intraretinal infiltrates (34% vs. 3.5%, p < 0.001), inner retinal hyperreflective spots (15.8% vs. 0%, p < 0.001), outer retinal atrophy (22.1% vs. 2.3%, p < 0.001), subretinal focal deposits (21.1% vs. 4.7%, p = 0.001), retinal pigmented epithelium (RPE) changes (49.5% vs. 3.5%, p < 0.001), and sub-RPE deposits (34.7% vs. 0%, p < 0.001). Features more frequently seen in uveitis included epiretinal membrane (ERM) (82.6% vs. 44.2%, p < 0.001), central macular thickening (95.3% vs. 51.6%, p < 0.001), cystoid macular edema (36% vs. 11.7%, p < 0.001), subretinal fluid (16.3% vs 6.4%, p = 0.04), and subfoveal fluid (16.3% vs. 3.2%, p = 0.003). Multivariate regression analysis controlling for age and sex showed absence of ERM (OR 0.14 [0.04,0.41], p < 0.001) and absence of central macular thickening (OR 0.03 [0,0.15], p = 0.02) were associated with VRL as opposed to uveitis.
CONCLUSIONS: OCT features most predictive of VRL (vs. uveitis) included absence of ERM and central macular thickening.