Keratic precipitates morphology in vitreoretinal lymphoma evaluated with in-vivo confocal microscopy

Abstract

A 51-year-old female patient presented to our department with a one-year history of bilateral blurred vision with floaters. Ocular examination showed bilateral vitritis with a moderate haze which was more accentuated and prominent at the periphery in the right eye (OD) (figure 1 A, asterisks). Spectral-domain optical coherence tomography (SD-OCT) showed numerous pigment epithelial detachment (figure B, white arrows), with a lumpy-bumpy choroid. The diagnosis of vitreoretinal lymphoma (VRL) was suspected and confirmed histologically by the presence of atypical lymphocytes in the vitreous samples and an elevated Interleukin (IL)-10 to IL-6 ratio. In addition to those posterior segment manifestations, slit-lamp examination of the OD showed central stellate granulomatous keratic precipitates (KPs) (figure C). On in-vivo confocal microscopy (IVCM), those infiltrating KPs appeared as a hyperreflective deposit at the level of the corneal endothelium with a dendritic shape, and were interconnected by multiple thin and fibrillar pseudopodia in a comet-like appearance (figure D, yellow arrows), which is a highly suggestive pattern of KPs of VRL associated anterior uveitis when the latter is unusually granulomatous.