Evaluating Optical Coherence Tomography (OCT) Findings as Potential Biomarkers in Central Nervous System (CNS) Lymphoma with or Without Ocular Involvement

Abstract

Purpose: To evaluate spectral domain optical coherence tomography (SD-OCT) findings as potential biomarkers in primary central nervous system lymphoma (PCNSL) with or without ocular involvement. Methods: The patient cohort finder tool at Stanford University Hospital was used to identify patients with any type of lymphoma using the ICD-10 codes (C82-C88), from January 2004 to October 2017. A total of 14,820 patients were identified. Procedure code (92134) for optical coherence tomography (OCT) was then applied to identify patients who underwent OCT at the ophthalmology clinic/Byers Eye Institute. Clinic charts of 460 patients with lymphoma who had undergone OCT were reviewed to identify patients with confirmed diagnosis of PCNSL and divided into two groups (Group 1: with and Group 2: without ocular involvement). Their SD-OCTs from within 1 month of the diagnosis were analyzed for the presence of 1) Hyperreflective deposits in choroid, retinal pigment epithelium (RPE), outer retina and inner retina; 2) RPE thickening; 3) Vitreous debris; 4) Intraretinal fluid; 5) Ellipsoid zone disruption by masked graders. Chi-square was used to analyze the difference in characteristics between the groups. Results: Twenty-two eyes of 11 patients with PCNSL were included this study (6 eyes in group 1 and 16 eyes in group 2). Mean age of subjects was 65 years (Group1: 60 years and Group 2: 67 years). Five patients (45.45%) were female (Group1: 3 and Group2: 7). There was no statistically significant difference between the groups for the presence of hyperreflective deposits in choroid, RPE, outer and inner retina, and the presence of RPE thickening, intraretinal fluid and ellipsoid zone disruption. Vitreous debris was found more commonly in group 1 subjects (83%) than group 2 (31.25%) (p=0.029). All subjects in both groups showed hyperreflective deposits in the RPE demonstrating RPE infiltration. However, RPE thickening was noted only in 3 patients (Group1: 1 and Group2: 2). Conclusions: Our study has demonstrated that the OCT findings of hyperreflective deposits present in eye with IOL secondary to PCNSL are also observed in eyes with PCNSL without ocular disease. These hyperreflective deposits can serve as biomarkers and aid in the early detection of ocular involvement by PCNSL. Funding Statement: funding was received for this project Declaration of Interests: QDN is a recipient of a Physician Scientist Award from Research to Prevent Blindness, New York, NY, and serves on the Scientific Advisory Board for AbbVie, Bayer, Genentech, Regeneron, and Santen, among others. No other authors have received any financial funding or support. The Byers Eye Institute has received research funding support from Research Prevent Blindness, Inc. Ethics Approval Statement: It was conducted in compliance with the Declaration of Helsinki, the United States Code of Federal Regulations Title 21, and the Harmonized Tripartite Guidelines for Good Clinical Practice (1996). The study was approved by local institutional review board. An informed consent waiver was obtained as charts of the selected patients were reviewed retrospectively.