MULTIMODAL IMAGING DURING THE EVOLUTION OF BLOOD-BRAIN BARRIER DISRUPTION MACULOPATHY.

PURPOSE: To highlight the course of blood-brain barrier disruption maculopathy in a patient with successfully managed relapsed central nervous system lymphoma.

METHODS: Case report with fundus autofluorescence and optical coherence tomography imaging, and literature review.

RESULTS: A 57-year-old patient diagnosed with central nervous system large B-cell lymphoma had a normal ophthalmic evaluation on his first visit. Subsequently, when his malignancy recurred locally, he was started on blood-brain barrier disruption therapy and intraarterial methotrexate. During the course of the therapy, he developed bilateral retinal pigment epithelial abnormalities located in the foveal and perifoveal zones. The changes were first mildly progressive and then marginally regressive in nature with minimal eventual loss of visual acuity to 20/32 and 20/25 in his right and left eye, respectively.

CONCLUSION: Maculopathy is a known complication in patients with central nervous system malignancies undergoing blood-brain barrier disruption. A detailed clinical evaluation using fundus autofluorescence and high-definition optical coherence tomography are informative in managing such patients.