Multimodal Imaging for Diagnosis and Follow-Up of Primary Vitreoretinal Lymphoma: A Systematic Review and Meta-Analysis Publisher Pubmed



Salari F ; Fakhredin H ; Samadi M ; Ghassemi F
Source: Graefe's Archive for Clinical and Experimental Ophthalmology Published:2026

Abstract

Purpose: To evaluate the imaging findings for diagnosis and monitoring of primary vitreoretinal lymphoma (PVRL). Methods: We performed a systematic search in PubMed and Embase databases to find eligible studies that reported the imaging features of PVRL. We calculated the pooled prevalence of optical coherence tomography (OCT), fluorescein angiography (FA), fundus autofluorescence (FAF), and indocyanine green angiography (ICGA) findings using R software with a Freeman-Tukey double arcsine transformation and a 95% confidence interval (CI). Results: Our analysis included eighteen studies with a total of 591 eyes. This review revealed vitreous opacity as the most common examination finding in PVRL (90% of eyes), followed by subretinal and retinal infiltration (45% of eyes). The prevalence rates for different OCT findings were as follows: The vitreous opacity at 79.68%, retinal pigment epithelium-Bruch’s membrane infiltration (RBI) at 43.46%, and retinal pigment epithelium hyperreflective material (RPEHR) at 45.56%, fuzzy outer retina at 39.32%, subretinal hyperreflective material (SHRM) at 39.68%, and pigment epithelial detachment (PED) at 15.26%. Leopard spots and multiple hypo-fluorescent spots were the most common findings in FA with pooled prevalence rates of 51.2% and 40.6%, respectively. Hyper-autofluorescent lesions in PVRL had a prevalence of 75.5%. In studies that reported ICGA findings, late persistent hypocyanescent lesions had a prevalence of 7.5%. In post-treatment OCT evaluations, subretinal hyperreflective material and pigment epithelial detachment decreased, and so did subretinal fluid and retinal hyperreflectivity. Conclusion: Multimodal imaging has the potential to greatly improve the diagnosis and monitoring of PVRL. The vitreous opacity, RBI, RPEHR, confluent fuzzy outer retina, and SHRM accompanied by shallow sub-RPE infiltration in OCT, as well as leopard spots in FA and hypofluorescent spots with reversal pattern of fluorescence and concurrent hypocyanescent spots in ICGA, are highly suggestive of PVRL diagnosis. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2025.