Frontiers in medicine · 2026
Optical coherence tomography features and visual prognosis in vitreoretinal lymphoma: a structured phenotyping study.
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Wang Xiaona, Liu Dehai, Li Yingyu, Zhang Pei, Dou Hongliang, Qi Hong
Аннотация
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.
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.