目的:报告并描述与原发性中枢神经系统淋巴瘤(PCNSL)相关的无症状玻璃体视网膜淋巴瘤(VRL)的眼部特征,通过检查临床和多模式影像学特征并与症状性VRL进行比较。
方法:回顾性横断面研究。
方法:纳入细胞学或分子学证实的VRL患者。患者分为三组:原发性VRL(PVRL),与PCNSL(PCNSL-S)相关的症状性VRL,或与PCNSL(PCNSL-AS)相关的无症状VRL。涵盖人口统计的数据,视觉症状,视敏度(VA),并收集影像学特征。使用单向ANOVA和多项线性回归分析对各组之间的定量和分类变量进行了横截面分析。
结果:该研究包括56例VRL患者的104只眼。29例患者(52%)被诊断为PVRL,27例患者(48%)被诊断为与PCNSL相关的VRL。其中,17例(63%)报告了视觉症状(PCNSL-S),10例(37%)无症状(PCNSL-AS)。PCNSL-AS患者的VA优于PVRL患者(0.11vs.0.76LogMAR,p=0.04)和不同的临床特征,眼前节受累率较低(比值比[OR]=0.02;95%置信区间[CI]0.12-0.84;p<0.01)和玻璃体炎(OR=0.32;95CI0.11-0.91;p=0.03)。与PVRL(OR=0.14;95CI0.02-1.11;p=0.06)和PCNSL-S(OR:0.08;95CI0.01-0.69p=0.05)相比,PCNSL-AS病例的视网膜下浸润较少,并且与较差的VA相关(估计值=0.55LogMAR;95CI0.29-0.8;p<0.01)。
结论:本研究描述了与PCNSL相关的无症状VRL的独特临床和影像学特征,特点是更好的VA和较少严重的眼部受累。这些发现强调了多模态成像在促进VRL在PCNSL分期中的早期检测中的关键作用。未来的PCNSL管理指南应考虑诊断无症状VRL患者的必要性。
OBJECTIVE: To report and characterize ocular features of asymptomatic vitreoretinal lymphoma (VRL) associated with primary central nervous system lymphoma (PCNSL), by examining clinical and multimodal imaging characteristics and comparing with symptomatic VRL.
METHODS: Retrospective cross-sectional study.
METHODS: Patients with cytologically or molecularly confirmed VRL were included. Patients were classified into three groups: primary VRL (PVRL), symptomatic VRL associated with PCNSL (PCNSL-S), or asymptomatic VRL associated with PCNSL (PCNSL-AS). Data encompassing demographics, visual symptoms, visual acuity (VA), and imaging characteristics were collected. Cross-sectional analyses of quantitative and categorical variables among groups were performed with one-way ANOVA and multinomial linear regression analyses.
RESULTS: The study included 104 eyes from 56 patients with VRL. Twenty-nine patients (52%) were diagnosed with PVRL, and 27 patients (48%) were diagnosed with VRL associated with PCNSL. Among these, 17 (63%) reported visual symptoms (PCNSL-S), whereas 10 (37%) were asymptomatic (PCNSL-AS). PCNSL-AS patients exhibited better VA than PVRL patients (0.11 vs 0.76 LogMAR, P = 0.04) and distinct clinical features, with lower rates of anterior segment involvement (odds ratio [OR] = 0.02; 95% confidence interval [CI] 0.12-0.84; P < .01) and vitritis (OR = 0.32; 95% CI 0.11-0.91; P = .03). Subretinal infiltration was less common in PCNSL-AS cases compared to PVRL (OR = 0.14; 95% CI 0.02-1.11; P = 0.06) and PCNSL-S (OR: 0.08; 95% CI 0.01-0.69 P = 0.05) and was associated with worse VA (estimate = 0.55 LogMAR; 95% CI 0.29-0.8; P < .01).
CONCLUSIONS: This study describes distinctive clinical and imaging features of asymptomatic VRL associated with PCNSL, characterized by better VA and less severe ocular involvement. The findings highlight the pivotal role of multimodal imaging in facilitating early detection of VRL in the staging of PCNSL. Future guidelines for PCNSL management should consider the necessity of diagnosing patients with asymptomatic VRL.