Intraocular lymphoma: experience from a tertiary referral center and review of the literature

The aim of the present thesis is to analyze the clinical presentation, diagnostic approaches, treatment modalities, and final outcomes of patients who were diagnosed with vitreoretinal lymphoma (VRL) over the last 20 years in a single tertiary care center. Through evaluation of trends in diagnosis and management, our aim is to explore potential advancements and challenges in VRL treatment. This study is a retrospective, single-center analysis performed at the University Hospital of Larissa, a tertiary referral center located in Central Greece. A retrospective review of medical records was performed for patients diagnosed with VRL at our institution between 2005 and 2024. We collected data regarding patients’ demographics, the symptoms at presentation, the diagnostic modalities used (multimodal imaging, cytology, flow cytometry, molecular testing), the treatment strategies (intravitreal, systemic, and/or radiation therapy), and final outcomes. Statistical analysis was performed to evaluate trends in diagnostic techniques, response to treatment, and overall survival rates over time. A total of 20 patients were included in the study (16 men (80%) and 4 women (20%). The mean age at diagnosis was 53 years, with a range of 15 to 70 years. In 14 patients (70%), the eye was identified as one of the initial sites of lymphoma. Among the 14 patients, 10 underwent vitreous biopsy, 3 had brain biopsy due to MRI-detected coexisting brain lesions at presentation, and 1 was diagnosed with a positive CSF IL-10/IL-6 ratio. Only 2 out of 10 vitreous biopsies (20%) returned positive results. The most frequently reported symptoms were floaters and painless vision loss. Out of 20 patients, 9 (45%) patients died, 1 (5%) patient committed suicide, while another 6 (30%) patients were lost to follow-up. Advances in diagnostic techniques facilitated earlier detection in the most recent years. Treatment approaches evolved, with an increasing shift toward targeted therapies. Our study highlights significant advancements in the diagnosis and management of VRL over the past decades. Improved diagnostic modalities and evolving treatment strategies have resulted in more favorable patient prognosis. However, challenges remain with respect to early diagnosis and long-term disease control. Future research should focus on novel biomarkers and targeted therapies to further enhance survival and quality of life in VRL patients.