Researchers in Milan were unsatisfied with the term vitreous haze because it delineated the presence of vitreous opacities without providing any specific cluster of diagnostic features. Their subsequent retrospective, observational study sought to characterize the vitreous involvement in vitreoretinal lymphoma (VRL) by combining clinical information and multimodal imaging.

The study identified three patterns: an aurora borealis pattern, a string of pearls pattern and a non-specific pattern. Researchers hope better characterization of the vitreous involvement might provide useful information to increase the clinical suspect of VRL, monitor the treatment response and identify recurrences in the vitreous chamber.

The study reviewed charts and imaging of 26 eyes of 13 patients with biopsy-proven VRL. Ultra-widefield imaging, ophthalmic ultrasonography and slit-lamp photography all contributed to the imaging information. At presentation, vitreous haze was present in 24 eyes (92%) and was the only sign of VRL in four eyes (15%).

The aurora borealis pattern— the most prominent in 12 eyes—showed linear opacities with myriad cells aligned along the vitreous fibrils. The non-specific pattern, observed in 10 eyes, was a corpuscular material correlating with the grading of vitreous haze. Researchers noted that the string of pearls pattern was the least common, even if quite peculiar. It was in two eyes and showed fine fibrils connecting bunches of inflammatory material.

The study suggested that that these patterns of vitreous haze might be helpful in increasing the suspicion for VRL. Researchers concluded that recognizing these patterns might justify the use of early invasive procedures, such as vitreal biopsy, to arrive at a definite diagnosis and hopefully reduce the diagnostic delay that patients with VRL still commonly encounter in clinical practice.

Marchese A, Miserocchi E, Giuffrè Cet al. Aurora borealis and string of pearls in vitreoretinal lymphoma: patterns of vitreous haze. Br J Ophthalmol. February 1, 2019. [Epub ahead of print].