Optical coherence tomography features and visual prognosis in vitreoretinal lymphoma: a structured phenotyping study

Abstract

Abstract

Purpose To characterize optical coherence tomography (OCT) features of vitreoretinal lymphoma (VRL) at baseline, identify features associated with visual prognosis, and describe longitudinal OCT changes following intravitreal methotrexate (IVT-MTX) treatment. Design Retrospective, single-center, observational study. Methods Consecutive biopsy-proven VRL cases were included. Spectral-domain OCT (SD-OCT) features were classified into three compartments: sub-retinal pigment epithelium (sub-RPE), subretinal, and intraretinal deposits. Additional features included ellipsoid zone (EZ) disruption, EZ-RPE attenuation, preretinal deposits, and vitreous cells. Patients were stratified as isolated VRL or VRL with concurrent central nervous system involvement (VRL-CNS). Best-corrected visual acuity (BCVA) was analyzed as a continuous variable (logMAR) using generalized estimating equations (GEE) with patient-level clustering, and an exploratory LASSO model was developed to predict significant vision loss (logMAR ≥ 0.5). A subgroup receiving standardized IVT-MTX with longitudinal OCT was analyzed across treatment phases. Results Thirty-eight eyes of 25 patients (14 female; mean age 63.5 ± 12.6 years) were included over a median follow-up of 14.2 months. Sub-RPE deposits were the most prevalent OCT feature (92.1%), followed by subretinal deposits (65.8%) and intraretinal deposits (23.7%). In the multivariable GEE model, baseline BCVA ( p = 0.009) and EZ disruption ( p = 0.026) were associated with worse visual outcome. In the LASSO model, EZ disruption and EZ-RPE attenuation were selected, and showed an AUC of 0.929 (0.872–0.992) for significant vision loss. Twelve eyes of 8 patients comprised the IVT-MTX longitudinal subgroup (mean 7.7 ± 0.8 injections). OCT features showed that vitreous cells resolved rapidly, sub-RPE and subretinal deposits regressed slowly, whereas EZ disruption remained unchanged. Conclusion Sub-RPE deposits are the most prevalent OCT finding in VRL. EZ disruption and EZ-RPE attenuation are associated with worse visual prognosis. Following IVT-MTX treatment, OCT reveals differential response patterns across lesion compartments, supporting quantitative OCT assessment as a sensitive, noninvasive tool for treatment monitoring.