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The following is a summary of “Vitreoretinal lymphoma: the importance of cerebral spinal fluid evaluation at initial diagnosis,” published in the October 2024 issue of Ophthalmology by Silverman et al. 

Researchers conducted a retrospective study to evaluate the patients with vitreoretinal lymphoma (VRL) and concomitant central nervous system lymphoma (CNSL) who might present without brain MRI findings but have cerebrospinal fluid (CSF) for lymphoma. 

They examined patients from Memorial Sloan Kettering Cancer Center from 2006 to 2024, focusing on individuals diagnosed or suspected of having VRL. Inclusion criteria required a final diagnosis of biopsy-proven CNSL and the completion of brain MRI with and without contrast, along with CSF evaluation (mandatory for inclusion if the MRI was negative) during the initial diagnostic assessment, while Exclusion criteria included prior treatment for CNS disease (brain, spine, or CSF) before ocular disease. Patients with previous extra-CNS disease were included. Clinical records and radiographic images were reviewed to collect relevant data and the patients with negative MRIs and CSF findings suspicious for lymphoma, with subgroup analysis covering imaging characteristics, pathology, treatment, and disease progression. 

The results showed that of 65 patients, 30 had negative MRI brain and CSF, 16 had positive brain MRI and negative CSF, and 8 had both positive MRI brain and CSF, while 11 (16.9%) had CSF suspicious for lymphoma without positive findings on MRI of the brain. In this subgroup, the median age was 66 years (range 49–82) and 36% were female, 86% of these patients were asymptomatic neurologically and 73% underwent systemic treatment while, 91% of patients were living at a mean 3 years of follow-up. 

They concluded that CSF evaluation in patients with suspected VRL was essential for an early detection of CNSL, as negative brain MRI could lead to missing 16.9% of cases. 

Source: bjo.bmj.com/content/early/2024/10/08/bjo-2024-325999