Diagnostic Value of Clinical and Optical Coherence Tomography Findings in Primary Vitreoretinal Lymphoma: A Retrospective Cohort Study.

Objectives: Primary vitreoretinal lymphoma (PVRL) is a rare intraocular malignancy that can frequently masquerade as chronic uveitis, leading to substantial diagnostic delay. This study aimed to evaluate the diagnostic contribution of clinical examination and optical coherence tomography (OCT) in PVRL, to quantify the relationship between structural OCT findings and visual acuity (VA), and to identify factors associated with the yield of diagnostic vitrectomy. Methods: We retrospectively analyzed 17 patients with cytologically confirmed PVRL evaluated at two ophthalmology centers in Bucharest, Romania (2018-2023). Demographic, clinical, and OCT data were collected. An exploratory five-item OCT score (retinal infiltrates, sub-retinal pigment epithelium [sub-RPE] lesions, outer retinal hyperreflectivity, outer retinal disorganization, and foveal involvement) was constructed. Associations with VA (logMAR) were assessed using Spearman correlation, Mann-Whitney U, and Fisher's exact tests. Results: Mean age was 66.1 ± 9.6 years (76.5% female); 76.5% had bilateral involvement at diagnosis, rising to 88.2% during follow-up. Median symptom duration before diagnosis was 250 days. The OCT score correlated strongly with VA (ρ = 0.772, p < 0.001). Outer retinal hyperreflectivity, sub-RPE lesions, retinal infiltrates, and outer retinal disorganization were each associated with significantly worse VA (all p < 0.05), whereas foveal involvement and subretinal fluid were not. A first vitrectomy was diagnostic in 82.4% of cases; prior corticosteroid exposure was significantly associated with an inconclusive initial cytology (Fisher's exact p = 0.015). Conclusions: OCT findings correlated with visual impairment may help stratify disease severity at diagnosis. Prior corticosteroid exposure was associated with a lower yield of first-attempt vitrectomy, supporting steroid withdrawal before biopsy when feasible. These OCT features occurred together rather than independently, and are therefore best interpreted as a single imaging phenotype.