A rare case of infiltrative optic neuropathy caused by vitreoretinal lymphoma with intraretinal and subretinal pigmented epithelial hyperreflective deposits prior to the disease onset

Abstract

Background To describe a rare case of infiltrative optic neuropathy caused by vitreoretinal lymphoma (VRL) with intraretinal and subretinal pigmented epithelial (RPE) hyperreflective deposits before the disease onset. Case presentation: We presented an 87-year-old Japanese female. At 5 months before onset, she noticed a decline of her right visual acuity, and she visited ophthalmology clinic because her visual acuity was progressively deteriorated to counting finger. In clinic, uveitis complicated with vitreous opacification (VO) was revealed, and subcapsular triamcinolone acetonide was injected for treatment. Although her visual acuity and VO were improved after treatment, she was referred to Osaka University Hospital for detailed examination. Her right visual acuity was 20/50. Intraocular inflammation and VO were not detected. There were yellowish-white deposits likes hard drusen in her right macula, and optical coherence tomography (OCT) showed intraretinal and sub-RPE hyperreflective deposits in the same area. One month later, she visited to our hospital with acute visual exacerbation. Her right visual acuity was hand motion. Optic disc swelling with disc hemorrhage was shown in the right eye. There was neither VO nor intraocular inflammation at this time, and a magnetic resonance imaging (MRI) of the head without enhancement did not show hyperintensity and swelling of the optic nerve as well as intracranial lesions. One week later, VO occurred and we performed 25-gauge vitrectomy for vitreous collection. Finally, after consideration of all the clinical examinations, a diagnosis was made of infiltrative optic nerve neuropathy with vitreoretinal B-cell lymphoma. Intraocular injection of methotrexate was administered a total of 6 times. At the time of the last visit (6 months after surgery), VO and optic disc swelling had disappeared. Careful observation was continued, but no recurrent findings including MRI was observed, and visual acuity in the right eye improved to 20/50. Conclusions Although there were reports on VRL advanced from intraretinal or sub-RPE hyperreflective deposits, there have been no studies that these OCT findings has progressed to infiltrative optic nerve neuropathy with VRL. When differentiating optic neuropathy, OCT may assist in the diagnosis by evaluating intraretinal and sub-RPE findings.