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Multimodal Imaging of Presumed Ocular Manifestations in End-Stage Diffuse Large B-Cell Lymphoma.

Serous retinal detachment in patients with lymphoma are rare,1,2 and we believe this is the first reported imaging of bilateral serous retinal and choroidal detachments presumed to be associated with diffuse large B-cell lymphoma. A 65-year-old Hispanic woman presented with gradual bilateral visual field constriction followed by rapid decrease in central vision over the course of 2 days. The patient’s history was significant for thrombocytopenia and double-hit (positive c-MYC and BCL-2 expression) diffuse large B-cell lymphoma, nonresponsive to multiple chemotherapy regimens (R-CHOP, R-EPOCH, gemcitabine–oxaliplatin, bendamustine–rituxan–dexamethasone, and DHAP). A negative lumbar puncture was taken 5 days before her symptoms. No repeat testing was performed. At presentation, best-corrected visual acuity was 20/200 in both eyes. Intraocular pressure was 16 mmHg in the right eye and 11 mmHg in the left. The patient was somnolent and difficult to keep awake. Pupils were normal and symmetrically reactive to light. The anterior chamber and vitreous were clear with neither cell nor sign of inflammation. Fundus examination revealed serous retinal detachments, large choroidal detachments, and granular subretinal deposits in both eyes which are highlighted in Figure 1. Ultra-widefield color and autofluorescence imaging was captured using the OPTOS P200DTx. Bilateral Fig. 1. Widefield color and autofluorescence imaging highlighting bilateral septated serous retinal detachments, choroidal detachments, and granular hyperautofluorescent deposits along the temporal arcades.