Bilateral Primary T cell Intraocular Lymphoma: Diagnostic Utility of Autofluorescence and Electroretinography

Background: Primary intraocular lymphoma is a rare malignancy. Within the subtypes of intraocular lymphoma, T cell intraocular lymphoma is seen much less often than B cell intraocular lymphoma, and when it occurs it is often a component of a primary systemic lymphoma. Intraocular lymphoma is typically diagnosed with clinical findings and biopsy. Here we demonstrate the diagnosis of T cell primary intraocular lymphoma in a fellow, asymptomatic eye of a patient with auto fluorescence and electroretinography who had primary intraocular lymphoma. Case Presentation: A 73-year-old female presented to the Jones Eye Institute due to blurred vision of the right eye. Fundus examination revealed creamy yellow sub retinal lesions as well as vitritis. After an extensive work up and multiple vitreous biopsies, she was diagnosed with T cell intraocular lymphoma. Auto fluorescence imaging showed signs of possible involvement of the fellow eye that were not visible clinically, which was later confirmed with electro diagnostic retinal testing. No evidence of systemic lymphoma was initially demonstrated on brain imaging, systemic imaging, or lumbar puncture. Conclusion: Intraocular lymphoma poses a diagnostic challenge to the treating physician, particularly if not associated with systemic disease. Definitive diagnosis depends on demonstration of malignant lymphoma cells in ocular specimens. Auto fluorescence and electro diagnostic retinal testing can assist in the diagnosis of disease in fellow eyes of unilaterally presenting cases.