Ocular Inflammation and Immunology section, Singapore National Eye Centre, Singapore.
St. Joseph Mercy Oakland, Pontiac, Michigan , United States.
Ocul Immunol Inflamm. 2021 Apr 3;29(3):507-520. doi: 10.1080/09273948.2021.1878233. Epub 2021 May 19.
To provide recommendations for diagnosis of vitreoretinal lymphoma (VRL).
Literature was reviewed for reports supporting the diagnosis of VRL. A questionnaire (Delphi 1 round) was distributed to 28 participants. In the second round (Delphi 2), items of the questionnaire not reaching consensus (75% agreement) were discussed to finalize the recommendations.
Presenting symptoms include floaters and painless loss of vision, vitreous cells organized into sheets or clumps. Retinal lesions are usually multifocal creamy/white in the outer retina. Other findings include retinal lesions with "leopard-skin" appearance and retinal pigment epithelium atrophy. Severe vitreous infiltration without macular edema is the most likely presentation. Diagnostic vitrectomy should be performed. Systemic corticosteroid should be discontinued at least 2 weeks before surgery. An interleukin (IL)-10:IL-6 ratio > 1, positive mutation for the myeloid differentiation primary response 88 gene and monoclonality are indicators of VRL. Multi-modal imaging (optical coherence tomography, fundus autofluorescence) are recommended.
A consensus meeting allowed the establishment of recommendations important for the diagnosis of VRL.
为玻璃体视网膜淋巴瘤（VRL）的诊断提供建议。
对支持 VRL 诊断的报告进行了文献回顾。向 28 名参与者分发了一份问卷（德尔菲法 1 轮）。在第二轮（德尔菲法 2）中，对未达成共识（75%的共识率）的问卷项目进行了讨论，以最终确定建议。
主要表现为眼前漂浮物和无痛性视力丧失，玻璃体细胞呈片状或团块状排列。视网膜病变通常在外层视网膜呈多发性奶油色/白色。其他发现包括具有“豹纹”外观的视网膜病变和视网膜色素上皮萎缩。最有可能出现严重玻璃体浸润而无黄斑水肿的表现。应进行诊断性玻璃体切除术。在手术前至少 2 周应停止全身皮质类固醇治疗。白细胞介素（IL）-10:IL-6 比值>1、髓系分化原初反应 88 基因阳性突变和单克隆性是 VRL 的指标。推荐使用多模态成像（光学相干断层扫描、眼底自发荧光）。
共识会议为 VRL 的诊断建立了重要的建议。
