The following is a summary of “Anterior segment involvement in vitreoretinal lymphoma: clinical manifestations, molecular findings and in vivo confocal microscopy,” published in the November 2023 issue of Ophthalmology by Marchese et al.

While the intermediate and posterior features of vitreoretinal lymphoma (VRL) are well-understood, anterior segment involvement must be explored.

Researchers conducted a retrospective study to characterize anterior segment manifestations of VRL and their association with molecular testing.

They analyzed patients with biopsy-proven VRL. Variables included when anterior segment manifestations were available, observations from slit-lamp photos, and in vivo confocal microscopy (IVCM). MYD88 L265P mutation, cytology in the aqueous humor, and retinal and systemic findings were analyzed.

The results showed 108 eyes of 55 VRL patients. During at least one visit, anterior segment involvement was seen in 55 eyes (51%) of 33 patients (60%). This involvement encompassed keratic precipitates with dendritiform (33 eyes), dust-like (16 eyes), and large granulomatous (12 eyes) morphologies. Additional manifestations included cells in the anterior chamber (51 eyes) and posterior synechiae (2 eyes). In 41 eyes with available in vivo confocal microscopy (IVCM), various keratic precipitate morphologies were identified, such as floral (66%), spikes (56%), and mulberry patterns (20%). The MYD88 L265P mutation was found in 48% (10/21) of eyes without anterior involvement and 65% (24/37) with anterior participation.

Investigators concluded that anterior segment involvement in VRL was common, presenting with diverse keratic precipitates and MYD88 L265P mutation even in eyes without overt anterior segment inflammation.

Source: bjo.bmj.com/content/early/2023/11/14/bjo-2023-324303