Recognizing Pseudonecrotic Retinal Lesions May Help Diagnose Vitreoretinal Lymphoma

Vitreoretinal lymphoma (VRL) is a rare ocular malignancy than can masquerade as many other conditions as it has a wide range of presentations. One possible indicator of VRL is the presence of pseudonecrotic lesions. In this analysis of patients with VRL, investigators found that patients who presented with pseudonecrotic retinal lesions were significantly more likely to have severe ocular changes than those that did not, and they identified several clinical patterns that could be used to assist in earlier identification of VRL.

Study Design

This was a single center, retrospective analysis of the clinical and imaging records of patients diagnosed with biopsy-proven vitreoretinal lymphoma. The study included 67 eyes of 40 patients. The analysis compared eyes with pseudonecrotic retinal lesions characterized by lymphomatous intraretinal infiltration to those with a nonnecrotic clinical presentation.

Outcomes

Among the 67 eyes included in the study, 24 eyes (19 patients) had pseudonecrotic retinal lesions. When comparing pseudonecrotic eyes to nonnecrotic eyes, pseudonecrosis was associated with worse presenting visual acuity (median 2.4 logMAR vs 0.5 logMAR, respectively) as well as more frequent optic disc swelling (79.2% vs 0%), retinal vasculitis (93.8% vs 4.7%), retinal hemorrhage (83.3% vs. 0%), and retinal detachment (79.2% vs 0%). Consistent with their presenting features, eyes with pseudonecrotic retinal lesions also had worse final visual acuity (median 2.4 logMAR vs 0.3 logMAR).

Limitations

The small sample size, single study center, and retrospective design limit the ability to draw broad conclusions from these data. Due to the tertiary referral nature of the study center, the proportion of eyes presenting with pseudonecrotic retinal lesions may be overestimated, as this is a less typical presentation for vitreoretinal lymphoma. Retinal lesions in the periphery could have been missed, as these areas are not always captured on standard imaging protocols.

Clinical Significance

Vitreoretinal lymphoma can present with pseudonecrotic retinal lesions, simulating inflammatory or infectious conditions such as retinal vasculitis. Clinicians should consider vitreoretinal lymphoma in the differential for patients presenting with a clinical picture of retinal necrosis, especially because such patients have worse visual acuity outcomes. Earlier diagnosis and treatment of vitreoretinal lymphoma in such cases may improve long-term visual prognosis.

Financial Disclosures: Dr. Lauren Dalvin discloses no financial relationships.