Changes of choroidal structure after treatment for primary intraocular lymphoma: retrospective, observational case series

Abstract

Background: We report changes of choroidal structure determined by binarization of enhanced depth imaging optical coherence tomographic (EDI-OCT) images after treatment for primary intraocular lymphoma (PIOL).

Methods: Five eyes of four patients with PIOL were examined by EDI-OCT before and 6 months after intravitreal methotrexate injections. In addition, 15 eyes of 15 normal individuals controlled by age and refractive error were examined by EDI-OCT. Binarization of the EDI-OCT images was performed using publicly accessible software (ImageJ). The examined area of the subfoveal choroid was 1,500 μm wide, and the dark areas that represented the luminal areas were traced by the Niblack method. Wilcoxon signed rank test was used to determine the significance of changes in the subfoveal choroidal thickness, interstitial area, and luminal area. Mann-Whitney U test was used to compare the parameters in the eyes with pretreatment PIOL and normal control eyes.

Results: The subfoveal choroidal thickness was significantly decreased after treatment (P = 0.0431). In the binarized images, the interstitial area was significantly decreased after treatment (P = 0.0431), while the luminal area was not significantly changed (P = 0.8927). After delayed onset of PIOL, increased interstitial area, thickened choroid and unchanged luminal area were observed in one eye. The interstitial area and choroidal thickness were significantly increased in the eyes with pretreatment PIOL compared with the normal control eyes (P = 0.0207, P = 0.0495, respectively), while the luminal area was not significantly different (P = 0.2752).

Conclusions: After treatment for PIOL, the EDI-OCT images showed a thinner choroid, and binarization of the EDI-OCT images showed significantly decreased interstitial areas compared with the luminal areas. The binarized EDI-OCT images can provide useful information on choroidal structure in eyes with PIOL, and combining these images with intraocular interleukin levels or fundus autofluorescence images should provide valuable information for determining the PIOL activity.

Fig. 1

Fundus photograph in the left eye of case 4. a Before treatment, fundus photograph after diagnostic vitrectomy shows small yellowish lesions resembling drusen in the posterior fundus. b Six months after the initial intravitreal methotrexate injection, the yellowish lesions have changed to retinal pigment epithelial atrophy

Fig. 2

Enhanced depth imaging optical coherence tomographic (EDI-OCT) images and converted binary images in case 4. Upper row shows EDI-OCT images before treatment, and lower row shows images 6 months after the initial intravitreal methotrexate injection. EDI-OCT images through the fovea (a, d) were converted to binary images using ImageJ software. a, d The luminal area (dark area, asterisks) and the interstitial area (light area, daggers) can be seen. The examined area was determined to be 1,500 μm wide in the subfoveal choroid. It extended vertically from the retinal pigment epithelium to the chorioscleral border, and the choroidal area was set with the ROI manager of ImageJ. The rectangle surrounded by a red line was excised, and the dark areas were traced by the Niblack method. b, e Merged images of the binarized images and the margins of traced areas. In the binarized images, the light pixels were defined as the interstitial choroid or choroidal stroma, and the dark pixels were defined as the luminal area. c, f Merged images of the original EDI-OCT images and the margins of traced areas show that the traced areas coincide with the dark choroidal areas of the EDI-OCT image