Presumed secondary vitreoretinal lymphoma with response to systemic therapy alone: case report

Introduction: Intraocular lymphoma is a rare malignancy with no standard treatment regimen. We describe a case of secondary vitreoretinal lymphoma (VRL) with excellent response to systemic chemotherapy alone without intravitreal treatment. Case Presentation: A 72-year-old male with a diagnosis of stage IVA diffuse large B-cell lymphoma presented for evaluation of subretinal involvement with visual acuity of 20/20-3 in the right eye and 20/100 in the left eye. Fundus examination was largely unremarkable. Fundus autofluorescence (FAF) showed hyperautofluorescence in the macula with an area of hypoautofluorescence that could not be detected on examination. Ocular coherence tomography (OCT) showed subretinal material in the macula. A biopsy was deferred and treatment plan involved observation of response to systemic chemotherapy. Six-month follow-up showed resolution of the subretinal material and near resolution of the hyperautofluorescence, consistent with response to treatment. Conclusion: Select cases of isolated secondary VRL may be appropriate for management with systemic chemotherapy alone. Multimodal imaging including fundus autofluorescence can demonstrate lesions that may be less apparent clinically. Imaging may also be used for characterization of lesions when biopsy is deferred.