A novel Finding in the Diagnosis of Primary Vitreoretinal Lymphoma: A Case Report.

PURPOSE: Introduce a unique case of primary vitreoretinal lymphoma with a new optical coherence tomography finding.

METHODS: A case report. A 67-year-old healthy man with complaints of blurry vision in his right eye.

RESULTS: The patient's visual acuity was 20/60 and 20/20 in the right and left eyes, respectively. Anterior segment exam of the right eye demonstrated mild inflammation. Dilated fundoscopy revealed 2+ vitreous haze and 4+ disc edema. Optical coherence tomography of the macula in the right eye revealed optic nerve head swelling and thickening of the retina. Fluorescein angiography demonstrated mild leakage and staining of vessels along the inferotemporal arcade in the right eye. Labs were within normal limits except positive Herpes simplex virus 1 IgG. Initially, the patient was treated for herpetic panuveitis for three weeks with a favorable response. However, the clinical condition deteriorated as a new abnormality was identified in the macular region of the right eye through optical coherence tomography. Considering intraocular lymphoma as a potential diagnosis, the patient underwent a diagnostic vitrectomy. The vitreous sample analysis confirmed PVRL through immunohistochemistry and flow cytometry. The patient exhibited a rapid response following the initiation of intravenous and intravitreal methotrexate treatment.

CONCLUSION: The presence of subretinal fluid accompanied by suspended hyperreflective lesions originating from the roof of the subretinal fluid pocket on the OCT of macula "stalactite sign" might serve as a characteristic sign indicative of primary vitreoretinal lymphoma; however, further investigation using robust studies is necessary to examine this hypothesis.