Clinical Features of Vitreoretinal Lymphoma Recurrences

Purpose: To describe the clinical features of intraocular recurrences in patients treated for primary and secondary vitreoretinal lymphoma. Methods: A retrospective consecutive case study was performed of patients diagnosed with primary vitreoretinal lymphoma or secondary vitreoretinal lymphoma at Massachusetts Eye and Ear who achieved clinical remission after initial treatment and subsequently developed intraocular recurrence. Clinical features at presentation and recurrence were compared. Results: Twenty-five eyes of 20 patients were included. Mean age at diagnosis was 63 years, and 20 eyes had primary vitreoretinal lymphoma. All eyes had vitreous cells at both presentation and recurrence. At recurrence, there were higher rates of subretinal infiltrates (40% vs 24%) and cystoid macular edema (16% vs 0%) compared with initial presentation. Overall, 44% of eyes had different clinical features at recurrence compared with initial presentation. Mean visual acuity declined from logMAR 0.20 (Snellen ~20/30) at presentation to logMAR 0.40 (Snellen ~20/50) at recurrence. The majority of eyes with local recurrence only were treated with intravitreal methotrexate. Conclusions: Vitreoretinal lymphoma recurrences can present with clinical features different from initial presentation. Subretinal infiltrates and cystoid macular edema were more commonly noted at recurrence. Clinicians should evaluate for features beyond vitreous cells when monitoring for recurrence.