Macular OCTA Biomarkers of Ocular Involvement in Patients With Primary Central Nervous System Lymphoma

Ocular involvement in primary central nervous system lymphoma (PCNSL) can be difficult to identify, highlighting the need for noninvasive biomarkers that may support its detection. We investigated optical coherence tomography angiography (OCTA) biomarkers associated with ocular involvement in PCNSL. This retrospective single-center study included 62 eyes from 36 patients with PCNSL after exclusion of confounding vitreoretinal disease and poor-quality OCTA scans. Eyes were classified as having ocular involvement (OI; n = 23) or no ocular involvement (NOI; n = 39), and follow-up OCTA was available for 23 eyes from 14 patients. Macular and optic-disc OCTA parameters were analyzed, and discriminatory performance was assessed using direction-corrected area under the receiver operating characteristic curve (AUC). OI eyes showed predominantly deep capillary plexus (DCP)-specific reductions in macular perfusion. DCP whole-image inferior hemifield perfusion density was lower in OI than NOI eyes (44.95 ± 6.01% vs. 51.06 ± 6.11%; p < 0.001; AUC, 0.776), as was DCP whole-image perfusion density (45.92 ± 6.12% vs. 51.98 ± 6.13%; p < 0.001; AUC, 0.764). In the follow-up subset, the corresponding AUCs were 0.947 and 0.932. Neither metric showed significant within-group changes over time, and longitudinal analyses revealed no consistent treatment-associated perfusion pattern. These findings identify a predominantly DCP-specific macular microvascular phenotype associated with ocular involvement in PCNSL and support DCP perfusion metrics as candidate noninvasive imaging biomarkers that may complement clinical assessment and intraocular fluid-based evaluation.